The Impatient Geography Patient

According to some elements of the press and social media all of us teachers have done nothing since March.  This has not been the case at my school or at any other school where I have friends.  By the 17th July there was a real school/Covid fatigue.  More opportunities were opening up and lockdown restrictions were being lifted.  I decided to take advantage of this and booked a weekend away for my husband and myself.

We decided to stay at a St Austell Brewery pub with rooms in Topsham – the Globe .  If you are in the area go and visit this little town on the River Exe as it is very pretty with quaint shops and interesting architecture.  If you have £3 million to spare you could live there in this waterfront property – Wixels a waterfront, Grade II listed home.

It was good to have a weekend away.  The Globe pub is great, the rooms are comfortable and pub grub is great (although it was a bit of a reduced menu at the time).  The landlord had considered all elements of Covid safety and it was great weather.  We went for a walk around the town and ended up at the Quay where we sat in the sunshine and enjoyed people watching.

The main purpose of the weekend away though was to revisit paddleboarding.  At the very start of this blog I wrote about how I’d had my first ever paddleboarding lesson (the lesson was on15th August 2017) at Mount Batten in Plymouth and what a fun morning it had been.  However, on our return I had a letter inviting me to the Primrose Breast Care centre and that was the beginning of the impatient patient.  Three years on – mastectomy, reconstruction, dad’s death, effects of Anastrozle with Covid 19 thrown into the mix and I was at a very low ebb.  In fact I was so far down that I needed some professional help to start to get up again.  This is where going away and then facing paddleboarding was going to help as a great diversion.

I had booked a paddle lesson with The Edge Watersports at Exmouth (Edge) and so we turned up at the required time, changed into our gear, put on the buoyancy aids and carried some paddleboards down to the slipway.  The first part of the lesson was a safety briefing and then we were out on the Estuary, hugging the beach area, we all had to throw ourselves into the water and climb back on our boards to prove we could and so that we wouldn’t be frightened of falling in as we were already wet! Going south along the beach was fine and then we had to cross the fairway (channel for boats) and make our way to a sandbank.  Paddling on the flat – either standing or kneeling is fine, paddling when a fast jet ski or boat has just roared up the fairway is a different matter as it creates a wake.  When there is a wake you are supposed to turn your board into it.  However, when your back is to the wake and it hits… it is easy to fall off and that is what everyone did.

We were in a group of about 10 people with 2 instructors.  Some were very proficient, some were not – I include myself in this category.  One of the instructors remained with the less proficient whilst the more confident made their way back across the fairway and to a different beach.  I eventually made it back to the slipway… by this time our two hours were up and it was a case of getting changed and going off.  Nick and I went for a cup of coffee and then walked along the promenade. It was a really hot summer day, there were lots of families on the beach in their own little pods.  It looked and felt normal.  It was the start of the summer holidays and although there was work to be done I was going to make the best of weather as in 10 days I would be off to Spain with my mum.

As the summer term progressed it felt as if normal was being continuously updated.  At school we had refined and developed our online teaching so that it followed the same format as lessons for our year 10 students.  Lessons start with a low stakes quiz so check students’ learning – to see what they have retained from the previous lesson, week and module.  It is all about drawing the long term memory into play so when the GCSEs have to be taken the students aren’t doing last minute cramming but feel confident and secure.

We taught using Google Meet as the medium and students were invited to join the class to access the learning, two teachers were in each class and lessons were recorded and saved to ensure there was no safeguarding issues.  Our year 10 students did remarkably well and the majority soon developed new habits to allow them to develop as learners.  Our school provided a timetable for students for years 7, 8, 9 which was online learning.  My job was to look after the year 7 Geography and I really enjoyed putting lessons together and having that online contact with the students.  Those who had engaged well got a praise email and I started to look up Geography puns… your work has been lavaly, your work rocks, etc.  They went down well and students replied with corney Geography jokes!

After half term I was back on the rota which meant I could contribute in person in school.  Our school was very well organised with small groups of students being in “bubbles” of no more than 10, a timetable, lots of hand sanitising equipment and frequent reminders about social distancing.  It felt odd but good to be back in the school environment – I felt that the students and staff had adapted to the new normal.   During this time we carried out a much reduced new staff induction with a focus on safeguarding and our pedagogy.

Gradually we worked our way to the 17th July and the end of term.  Our leadership team met in person, we were in a large classroom and it was great to meet colleagues/friends to review what had happened since March and to start to plan for September.  Normal had been updated and the proof of the pudding would be how it was implemented with all the students back… but there is a while to wait for that!

For the last two Thursday evenings at 8pm the nation has come out to acknowledge the work of those who are key workers and in particular the NHS.

I have many reasons to be grateful to the NHS.  I was born in a NHS hospital in Dover, my own children were born at Freedom Fields NHS hospital in Plymouth.  I’ve had my lumpy thyroid removed and shoulder rebuilt care of the NHS. NHS screening detected breast cancer, NHS consultants and nurses removed the cancer and rebuilt me.  The NHS sorted Nick’s hernia and gave my mum a new hip, the NHS looked after my dad until he couldn’t be looked after any more.  My sister in law works as a nurse for the NHS in North Yorkshire, she has been redeployed from endoscopy to critical care.  Our friend Salvo, his son Joe and Joe’s fiancee Jess are all on the front line as Senior and Junior doctors at local NHS hospitals.  Miles’ great friend and Best Man to be, George is also a Junior doctor.  My Godmother, Yvonne worked for many years as a Theatre Sister for the NHS in Cheltenham.

It strikes me that we are all in this together.  Never in my life time has it appeared so palpable that we are working together – we can all do our part, from the cleaner, to the shopkeeper, to the teacher, to the utilities worker to the surgeon we are all in it together.

One of my colleagues, Emma has shared this poem which I will send out as part of a Good Morning email next week. Michael Rosen is recovering from Coronavirus.

You may have picked up on previous Impatient Geography Patient posts that I really do love my job!  Not everyone can say this but I am in the best school I’ve ever worked in and I intend to see my career out in this one. What makes it a good place to work…

• The people – staff and students
• The teamwork – we are in it together
• The vision to do better – if we get it right those kids will have better life chances and some of them may have to look after me when I’m older.. (no need to be be too altruistic)
• The commute – it is a 5 minute walk (I’m doing such good for the environment!)

There are plenty of things I’d like to change if I had a magic wand but we won’t go there in detail as I don’t own one (the main thing I’d change is the buildings… having been able to visit some new build schools with wide sweeping staircases and corridors I’ve got school building envy).

It is odd working from home.  Getting a good routine has been a challenge but I’m sort of organised and one of my roles is to think about staff wellbeing.  To do this I write a “Good Morning” email each day to all staff.  This consists of some links to web sites, some for fun, some for mental wellbeing, a photo from a very talented young photographer who has been walking through Plymouth’s empty streets (you can find him on Facebook he is called Jay Stone and he has given me permission to use his images) and a poem which is supplied by three fabulous colleagues in the English Faculty.

My colleagues (friends) have been great… they’ve sent me links to share, over the past couple of days they’ve sent me photos of their pets and of themselves as children so we can have a bit of fun guessing who is who or who owns which pet.  I’ve had some lovely feedback emails too from some who say how much they enjoy receiving a daily email – it is purely voluntary so if people don’t wish to engage, they don’t have to.  Similarly if they don’t want to look at the links they don’t need to.  Doing this little job is certainly helping my wellbeing.  My favourite so far is the online book club – we are listening to the Mirror and the Light on BBC Sounds, this is the third in Hilary Mantel’s trilogy about Henry VIII and Thomas Cromwell.  Wolf Hall, Bring up the Bodies and now this, I’m tempted to listen ahead.

Student wellbeing is being cared for too.  Tutors phone the parents/tutees once a week to ensure that all is well and the response from parents has been very positive.  Line managers phone their teams once a week too.  We are a community.

Being able to work like this gives me something to discuss with Nick too.. this is a good thing as he is pretty fed up and finding this concept of a lockdown more difficult than I am.  He loves sailing, he and his great friend Dave have spent a huge chunk of time preparing Cumulus for the lift back into the water on the 8th April.  Sadly, the boat club is closed, to “work” on the boat is not essential and involves crossing the Tamar on the Torpoint Ferry so is frowned upon and he has been told that those who have been sailing have been sent back to their moorings by the river Police.

This too will pass.

After one of the wettest winters on record the weather had improved.  There was high pressure over the UK and, although cold there was bright sunshine.  Perfect weather for people to go out and about.  Except it wasn’t really perfect to go out and about as the Coronavirus was establishing a foothold in the UK.  What had seemed very distant in China and moderately distant in Italy now seemed very close.  BBC reports talked about “flattening the curve” by social distancing, most days there was a political briefing, the number of infections had risen, the number of deaths with Covid 19 had increased – there had been deaths at Derriford Hospital.  The weekend weather was fine and some people flocked to natural  beauty spots, beaches and parks.

The Coronavirus Act 2020 was given Royal assent on 25th March, fast tracked through Parliament and came into force on 26th March.  The aims of the Act are

• to give further powers to the government to slow the spread of the virus
• to reduce the resourcing and administrative burden on public bodies
• to limit the impact of potential staffing shortages on the delivery of public services.

There has been some criticism of the Police, suggesting that some Constabularies are being heavy handed about enforcing the Act.  Derbyshire Constabulary has been the most vocally criticised for using drones to shame people who have visited beauty spots. I am obviously too compliant.  I have been told… stay home, save lives, protect the NHS and that is what I have done.  I didn’t leave the house for 10 days, other than to sit in the garden.  Since then I’ve gone for a walk once a day for an hour or so, have been to a local shop for bread and milk and that is that.

My plans to catch up with all of Joe Wick’s PE sessions and to join online Barre, Pilates, etc have been stimeyed as I just haven’t felt well enough.  Walking up hill has been a struggle as my chest still hurts.

I have missed seeing my friends and especially my mum.  However, Whatsapp and Zoom have allowed me to meet with them.  We’ve have a Zoom cheese and wine party (I didn’t have either) and I’ve spoken to my mum frequently.  I’ve spoken to Marcus in Seattle, he has been working from home with his wife, I’ve spoken to Miles in Cheltenham.. he and Corey, his fiancee have both had all the symptoms of Covid 19: fever, cough, no sense of taste or smell, fortunately, they are young and healthy and on the mend.

Actually, week one was not so difficult as I wasn’t particularly well but I don’t know if I have had the dreaded virus or a version of end of termitis.

I developed a cracking headache over the weekend, we’d had the information that we were to partially close, everyone appeared to be on tenterhooks, I thought my headache was stress related.  Like Donald Rumsfeld with his quote I didn’t really know what I knew and what I didn’t

“there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know.:

I like to be a creature of certainty, routine – the news about the partial closure and ramifications was enough to give anyone a stress headache.

I packed my office after our final briefing on Monday, took home files, books, reading… it was unknown how long we were going to be working remotely.  We had a phase one four week plan, but the news was talking about twelve weeks or even not going back until September.  There was lots to think about – not least the GCSEs and A Levels.

My headache progressed into a sore throat and a feeling of utter weariness on Monday night and into Tuesday.  Tuesday dragged, Wednesday and Thursday saw me laid out in bed, slight fever, lemsip at regular intervals but not the Coronavirus symptoms of a high temperature and dry cough.  I certainly felt rough.  On Friday I dragged my sorry carcass out of bed and attended an online meeting, it was fine, I took notes to do the minutes.  I joined the virtual coffee break – I was over the worst.  On Saturday I pottered about… got up did some tidying up, sprayed all handles and light switches with Zoflora and made a rhubarb crumble cake.. I was obviously much better.  And then I wasn’t… Saturday night was sleepless and hot (fever or hot flushes – who knew?), Sunday it was as if I was back to square one but with a very tight chest, no cough, no more fever but so fatigued, so I stayed in bed.  Fortunately, my local Matron (Nick) had lost none of his skills and brought breakfast in bed, coffee, lemsip and I slept most of the day.  Week one done.

Our leadership team meetings had one vital focus – the welfare of students and staff.  Our student cohort does consist of some very vulnerable young people, many of whom rely on school for sustenance. Plans were made, adapted, shared so that by Monday 23rd March we were ready.  Texts, emails, website messages had all been sent out so that parents were well informed about what was happening.  The catering team had a plan to feed those in need, a large donation was made to a local food bank – after all many of our students relied on this and we would not have the 1,400 people in school for the next week or so that we usually did.

We had a well distanced leadership team briefing on Monday morning.  The Principal and other members of the executive team had been working all weekend.  There were three tranches – welfare, education, admin.  Teams of colleagues were briefed and ready to go.  A four week rota was in place.  All non-essential staff were to go home after their briefing.  Plans were put in place and executed to feed our students, to educate them online and to keep everyone informed.

We are a “Google” school – we use Google platforms such as gmail and already had Google classrooms in place.  These were adapted so that students could access home learning over the first week (as long as they had access to the internet).  We became more proficient at using Google Meet – a bit like Facebook messenger or Zoom, this means we can have online meetings and we do.  Each morning at 11am there is a virtual coffee break (I have to confess I’ve missed the last couple) and we’ve had leadership team meetings with the usual routine, the Principal chairs the meeting, we have an agenda, when you want to contribute you unclick the mute button and then when the time is right you can share your information, we have minutes and follow up actions. It is a virtual meeting and instead of being around the boardroom table we are in our own homes.  I’m lucky as I have a study, my bargain desk (25 quid from the British Heart Foundation shop, rubbed down and painted grey) is large enough to hold my laptop, chrome book and i-pad as well as notebooks and a basket of stationery.  Phoebe helped me to realign it so now it looks out over the garden, the wisteria is in bud, Spring is springing and it has not been onerous to sit at my desk and contribute remotely.

Teaching is a sociable profession, you have to like people – young, middling and older as you work with several hundred.  I was very worried about the impact of social isolation, I like people, I found it hard to be at home when recovering from the mastectomy and rebuild, however, with everyone in the same boat it might be easier to tolerate.

This is the end of the second week of being at home.

From the end of January until the middle of March there was much in the world press about a new virus Covid 19.  This virus appeared to originate in China and with the impact of globalisation had spread around the world.  It all seemed alarming but distant.  New hospitals being built in Wuhan didn’t appear to be linked to life in Plymouth.  Plans were made as usual, school was running as usual, Covid 19 was on the horizon but unlike Italy or Spain there was no real talk of self isolation, social distancing and closing of schools, industries and normal life.

And then there was…

On the BBC news there started to be reports of patients, usually vulnerable who had died with (not of) Covid 19.  The news from Italy was disturbing and by mid March it seemed that this distant virus had established a strong foothold in Europe.  Not so distant.

I kept a beady eye on Easyjet – I’d arranged for my mum and I to go to southern Spain for a week during the Easter holidays.  The flights had not been cancelled, Spain was experiencing issues but mainly in Madrid, everything had been booked – flights, apartment, transfers in mid January.  It was becoming less and less likely that we’d be able to go.  I’d contacted the apartment and their recommendation was to “modify” the booking.  Modify to what and when though?  Still nothing from Easyjet other than an email to say that they had changed the aircraft and I’d have to “manage my booking” to change the seats.

School was going ahead as normal, the run up to the Easter break included ensuring there were revision sessions for students during the holiday.  We kept an eye on staff to make sure there was nothing untoward.  Gradually, some colleagues and students started to self isolate as they were unwell.  We are a large cohort so had plans in place to manage to keep open, collapsing classes, using the hall as a large learning space.   The news was becoming more urgent and on the 18th March the Government announced that schools were to partially close on the 20th, closed to all but the most vulnerable students and those children of key workers.  From Wednesday night until Friday there was a flurry of activity.

On the 17th January at my visit with Mr X I had dressed the toob with googly eyes and pink ears, I drew on two nostrils – I was ready for school and then my appointments – to review the medication and surgical review.

Both Mr X and Sue were thrilled with the result of the toob (though not entirely surprised to see it dressed as a pig) and how well my tummy scar is healing.  As the impatient patient I thought it should be completely healed not red and livid still.  The toob was one of the best that Mr X had seen and it felt/feels so much better than the wretched cannonball.  The next stage would be to have a nipple and Mr X said he’d add me to the list and in a few months I’d hear and have an appointment.

Now the NHS has many naysayers but not I.  I’d had my appointment on Friday and the following Monday just before year 9 were going to be ushered into my classroom my phone went and as I was on the threshold I took the call.  It was the plastics team, there had been a cancellation and could I come up for a nipple reconstruction the next day.  I thought I could, the boss said I could and so I got prepped by viewing a you tube reconstruction that evening.  Nipple surgery (a bit graphic)

Tuesday morning, school as usual and at 11.30 Nick took me up to Derriford to the Freedom Unit.. only I could buy some lunch first at M&S as this was a local anesthetic procedure.   I made my way past the smokers, some who appeared to be on drips, through the concourse and followed the signs to the Freedom Unit.  I paused to eat my sandwich and then got a bit lost – so I asked for directions and was asked if I was a Doctor or Patient, how funny, must have been the school uniform and lanyards.

Once in the Freedom Unit I was booked in quickly and given a gown, but could keep my bottom half on.  Mr X, the young South African registrar (who’d helped with the DIEP) and a trainee (but not work experience person) came through and I was invited to be marked up in an office.  A submarine shape drawing was added to the pig’s snout – the wings were going to make the edges of the nipple and the conning tower the top.  I was very insistent this must not be as big as a malteser or Lindt chocolate.  I asked if I was allowed to talk during the op and the answer was yes! I had to wait an hour or so as there was a lady ahead of me so I got my marking out, completed marking year 9 assessments, checked my emails and did a bit of planning as I’d brought my chrome book.  No point in wasting time.

I was called in… final checks and I was in the theatre.  I was introduced to everyone including the student nurse, former fitness instructor, who had a job as a theatre nurse on finishing her studies.  My bag and marking were deposited, I reclined on the theatre bed, was scrubbed up with some form of iodine solution and covered in a blue theatre sheet which was stuck on allowing free access to my chest.  Mr X injected the snout with lidocaine  – but I couldn’t feel the injection on the toob and then he made incisions around the submarine and stitched up a new nipple for me.  I chuntered on to anyone who’d talk to me, we talked about the cost of training to be a doctor to what it was like to teach and how well my year 9’s had done… not that well, I blame their teacher!  I was amazed at the size of the theatre and all the equipment around, the light was not as good as the one at the dentist as I couldn’t see my reflection in it to check the nipple was not malteser sized.  A big dressing on the wound to finish it and then… into a wheelchair to go to recovery.  I told them all I could walk to recovery but they were insistent on the wheelchair.  A cup of fruity tea and a couple of biscuits later Nick came to pick me up – had arrived with one nipple and left 6 hours later with two.  Another step on the path to looking more “normal”.

The dressing was to stay on for a week to ten days and then it was back to the Primrose clinic to have it removed and the stitches out.  What a result! Perfect.  Sue cut the stitches and used tweezers to remove them.  No malteser, definitely not a Lindt chocolate but a really good match for the original one. Phew! Next stage a tattoo in 4 months or so for an areola.  Thank you Primrose, Onco-Plastics and Derriford.

On the 17th January I was back at Derriford Hospital for a post surgery check with Mr X and Sue the BCN.  The free flap DIEP reconstruction had taken place in the previous July and despite thinking I would never stand up straight again, would never bend, lie on my side or be “normal”… 7 months on I could do all of the above and more.  I was able to go to pilates, spin, was back at work full time.  When I caught sight of myself getting changed or dried the toob looked pretty good – there was no nipple and the circular scar made of my tummy which might be an areola eventually did remind me slightly of a pig’s snout minus the nostrils.

I’m a trustee of the Primrose Foundation and I take my responsibilities seriously. I read the papers sent to me and I look carefully at the applications for funding.  One such application was for a bursary for training for a fellow to join the oncoplastics team.  The application was for £10,000.  I spoke to the D2 ladies and we agreed that we would like our fundraising to support.  This is what was on the the Primrose Foundation web site wrote:

A new £10,000 bursary for the newly appointed Plastic Clinical fellow with a specialist interest in Breast reconstruction which has recently been developed within the Plastic & reconstructive surgical directorate at University Hospitals Plymouth. 

This post will play a vital role to anyone who requires breast reconstruction after breast cancer and means that patients will now be offered free flap breast reconstruction as an option.

So when I saw Mr X with the pigs snout I told him that the D2 ladies would like to ensure that the money we raised at the second D2 ball would support the fellowship to ensure that more women in the Plymouth area would have access to a free flap/DIEP reconstruction.  The next step was to arrange the cheque presentation.  This was arranged at the Duke of Cornwall – afternoon tea with a variety of options from vegan to full fat.  It was a lovely afternoon, jolly, fun and a way to celebrate how we had managed to work together over two years to raise over £23,000 – something quite extraordinary for 9 women who’d never raised money like this before. The funds also support.. a new quiet room refurbishment and a clinical psychologist to help women who are thinking of a reconstruction.