Trans Health

On Friday 13 September 2019 the first in the list of Trans News items on the Google News page is from the BBC: Transgender waiting lists 'putting people at risk'.
The article discusses how long people that identify as being Transgender sometimes have to wait before receiving any specialist medical help.
It begins with the words:

Transgender people are being put at greater risk of suicide and self-harm because of "unacceptably" long waits for specialist medical clinics in Scotland, according to campaigners.

The Scottish Trans Alliance (STA) (which has been funded by the Scottish Government Equality Unit since 2007) is mentioned in several places in the article.
The article also mentions that:

At the start of 2019, almost 300 people had been waiting more than a year for a first appointment with a specialist.
NHS guidelines say gender dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity.
The condition is not covered by the NHS's 18-weeks referral-to-treatment target but the STA thinks the first appointment with a specialist should be within that timescale, because delays can take a "real toll" in terms of depression and anxiety.

The article also includes an analysis by BBC Scotland Health Correspondent Lisa Summers.
The analysis includes some of the story of some of the experiences of a trans man named Alex McIntosh. And also Dr Jo Gardiner, a GP who has seen a growing number of transgender patients.
James Morton of the STA mentions:

The long waits to begin hormone therapy in particular can put people at greater risk of hate crime.
If you're trying to live in your gender identity in society, but you haven't been able to access hormones or surgery, then your physical appearance is more likely to indicate you are trans.
So it can create a high level of risk in social situations and take a real toll in terms of depression and anxiety.

And my thoughts?
The National Health Service (NHS) in the UK is under pressure from many sides. It's has a difficult job to do in balancing funding with meeting the needs of people. Over recent years there has been quite a lot written and said about failings in the provision of mental health care. For example there's an article in the Guardian here, and from the Parliamentary and Health Service Ombudsman here.
There's an article in the Lancet entitled Trans* health: “diversity, not pathology which mentions:

“Being transsexual, transgender, or gender non-conforming is a matter of diversity, not pathology”. This statement is from The World Professional Association for Transgender Health (WPATH) Standards of Care, 2011 guidelines, which provide clinical guidance for health professionals and challenge medical classification that has long considered gender identity disorder, a term that has largely been replaced by gender dysphoria, to be a mental health problem.
As WPATH point out, “some people experience gender dysphoria at such a level that the distress meets criteria for a formal diagnosis that might be classified as a mental disorder.” However, gender dysphoria is not caused by psychopathology or mental illness, but is mainly an issue with identity. Misdiagnosis, or simply overlooking gender dysphoria is misleading, unhelpful, and harmful. Not only does it compound social stigma but it also misinforms the medical profession. Gender dysphoria is not a mental illness; however, internal biological conflicts—a yearning to live in the gender role dictated by the brain, not the genital sex, or phenotype—might lead to a mental health diagnosis.

The NHS says:

Gender dysphoria is a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity. It's sometimes known as gender incongruence.
Biological sex is assigned at birth, depending on the appearance of the genitals. Gender identity is the gender that a person "identifies" with or feels themselves to be.
While biological sex and gender identity are the same for most people, this isn't the case for everyone. For example, some people may have the anatomy of a man, but identify themselves as a woman, while others may not feel they're definitively either male or female.
This mismatch between sex and gender identity can lead to distressing and uncomfortable feelings that are called gender dysphoria. Gender dysphoria is a recognised medical condition, for which treatment is sometimes appropriate. It's not a mental illness.
Some people with gender dysphoria have a strong and persistent desire to live according to their gender identity, rather than their biological sex. These people are sometimes called transsexual or trans people. Some trans people have treatment to make their physical appearance more consistent with their gender identity.

According to this article in The Independent

The World Health Organisation (WHO) no longer categorises being transgender as a "mental disorder".
On Saturday 25 May [2019], the health agency approved an update to its International Statistical Classification of Diseases and Related Health Problems (ICD-11), a manual used globally to diagnose diseases.
The decision to remove transgender identities from the ICD-11's classification of mental disorders was announced by WHO in June last year.
The update has now been approved via a vote held by the World Health Assembly, the WHO's governing body which represents the organisation's 194 member states.
The changes to the health manual will come into effect on 1 January 2022.

The view is that to be transgender is not to have a mental illness.
Having said that, to be trans and to have to  hide the fact can cause distress. And sometimes that distress can be so great that it can lead to mental health issues.
It's vital that the NHS either invests more in making specialist help available to people that identify and being trans much sooner than seems to be the case at the moment, or changes the way that services are provided so that GPs are able to offer better support.
To be honest, though, probably both of these are needed.

It’s not what you say it’s the way that you say it

Here are a few comments taken from here on the article in The Guardian entitled: Against Me's Laura Jane Grace slams Arcade Fire for transgender video that I already mentioned in an earlier post here.

This isn't a video about a transsexual girl, not to me. It's about a transvestite girl. Transvestites aren't welcome in the TG community by many transsexual girls, who resent the sexual aspect mudding up their waters. It's quite odd when you think we're their natural cheerleaders.

received the following response:

Transvestite is to transgender people what the N word is to black people. Please do not use it. I believe the term you were looking for was drag queen. Or transgender (which is a broad term that can refer to a host of types of people, from drag queens to cross dressers to transsexuals).

to which I replied:

Actually, I know many transgendered people that aren't at all offended by the term "transvestite".

to which another replied:

As a trans woman, I am deeply offended by anyone that tries to call me a "transvestite". The term is ONLY properly applied to cis folk that like to dress as the opposite sex for personally gratification, not as part of their actual identity.

I can understand that someone identifying themselves as a trans woman is offended by people referring to her as a transvestite.

I am, though, a bit saddened that a trans woman doesn’t realise that a person that identifies themselves as transvestite might feel offended by someone who refers to them as simply cis folk that like to dress as the opposite sex for personally gratification, not as part of their actual identity.

Maybe it depends a bit on exactly what the word gratification is intended to mean.

But many, many of the people that I know that identify with the term transvestite would also say that it is part of their actual identity. It isn’t just about some kind of gratification. It’s a means of self expression.

Maybe there’s a  difference in meaning of the word transvestite in the UK compared with the USA. Since The Guardian is a UK-based newspaper – as am I (UK based, that is, but not a newspaper) I’ve stuck with the UK meaning of the word.

Here are a few definitions from the Gender Dysphoria section of the National Health Service Web Site:

Gender terminology

Gender dysphoria is a complex condition that can be difficult to understand. Therefore, it helps to distinguish between the meanings of different gender-related terms:

• gender dysphoria – discomfort or distress caused by a mismatch between a person’s gender identity and their biological sex assigned at birth
• transsexualism – the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to have treatment to make their physical appearance more consistent with their gender identity
• transvestism – where a person occasionally wears clothes typically associated with the opposite gender (cross-dressing) for a variety of reasons
• genderqueer - an umbrella term used to describe gender identities other than man and woman - for example, those who are both man and woman, or neither man nor woman, or moving between genders

I think the term for a variety of reasons is important here. Maybe many transvestites also fall into the genderqueer category as well.

Actually quite a lot of people don’t fall into such neat categories at all. 

People are often more complex than that.

Also, this article is interesting: Transvestites and cross-dressing at netdoctor.

To be honest, I can cope with people that use incorrect terminology through ignorance. I’m using the word ignorance in a non-stigmatic kind of way here. If a person has never been told something then how can they be expected to know all about it?

Quite often it’s not the actual words that people use that are hurtful and offensive. Always it’s the way that the words are used and the context that they are used in that makes all the difference.

I thought a lot before using the word “Always” in the sentence above. But I think it’s the right word.

I think that’s the reason I find it difficult to understand why some transgendered people have had such a big problem with the video, and even more difficult to understand the way in which some have expressed their dissatisfaction.

Whatever the video is, I’m sure in my own heart that the intension was good.

But if I had been involved in the production of it I could easily have felt quite offended at the following comment. It uses smooth words, but they have sharp edges:

Yet another attempt by segment s of the cisgender community to marginalize transgender folk. The band's spokesperson made matters worse by slapping whitewash on their video by trying to claim this was really about a gay boy and his father. Caught in a lie and no way out must be very uncomfortable for the band, right now.

Creative license is one thing. Outright lying to save ones "pride" is another. The trans community has every right to be outraged by this latest example of denigration and the subsequent attempt by the abusers to cover their tracks.

Maybe I’m being too picky/fussy in all of this.

What do you guys, girls and genderqueer folk think?

Girls, Guys, Shades of Gender, Suspender Belts and Pay Cuts

A little while ago I was involved in conversation with a transvestite that raised some thought provoking ideas.

She seemed to feel that all transvestites are on a path that leads to a need for more and more time to be spent as a girl. Less and less as a guy.

That as time passes there’s a need to be more and more girl-like and less and less guy-like.

And that there’s an inevitability in all of this for all concerned.

As we talked I expressed my disagreement.

For myself I feel at peace with where I am at. My life is a mix of guy and girl, masculine and feminine. I don’t feel a need for the balance that there is at the moment to change.

I know that different people have different feelings and experiences. But I also know what my own are.

Actually at times all these kind of terms can get surprisingly confusing.

Girl, guy. Man, woman.Male, female.Masculine, feminine.Gender, sex. And I think that we (including myself) sometimes use some of these words interchangeably when they aren’t always quite so interchangeable.

However, having spent a little time looking around the WEB at definitions of some of these terms, there seems to be some confusion there as well.

There’s an interesting article here: Sex Difference vs. Gender Difference? Oh, I'm So Confused! – but it isn’t easy reading.

There’s an article on the UK National Health Service WEB site entitled : Gender dysphoria which also seems a little odd. It says:

Biological sex is assigned at birth, depending on the appearance of the infant. Gender identity is the gender that a person “identifies” with, or feels themselves to be.

and also says:

Gender can be defined using very narrow medical terms such as what types of chromosomes you have, or what types of genitals you were born with. However, many transsexuals (and also many experts in the treatment of gender dysphoria) find this type of narrow definition both unhelpful and offensive.

Whilst the World Health Organisation says:

"Sex" refers to the biological and physiological characteristics that define men and women.

"Gender" refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women

My own feeling is that there is more to gender than the World Health Organisation gives credit to. And they definitely have a different understanding of the word sex than do most of the people that I know.

I have a feeling that somewhere in all of this the word psychology should also appear.

I’ve heard it said, and I think that I’ve mentioned it previously in other blog posts, that there’s a view that gender is a line that joins masculine to feminine and that different people are at different places along the line.

There are times when people feel compelled to live their lives as though they were at a position on this line that they don’t really feel that they are really at.

Sometimes even at entirely the wrong end of the line.

Also, for many, the pressure to conform to a role that is either purely masculine or purely feminine has been intense and damaging.

The good news is that the pressure is, in some places at least, lessening. People are being allowed to be themselves. There’s still a long, long way to go, but at least things are moving.

I have this feeling that there are many more than 50 shades of gender, and that they aren’t all grey.

Over the years I’ve grown to accept and, in a way, celebrate, my own gender and have been fortunate enough to have family and friends that are able to accept it as well.

I feel that my position isn’t at either end of the gender line and I’m OK with that. The makeup and feminine clothing that I wear at times is an expression of this.

Actually it’s not just about gender in the sense of socially constructed roles. Nor is it just about sex or genital surgery. It’s more about who I feel that I am. It’s an expression of myself.

I think that different people are in different places when it comes to gender.

That there are lots of people that are in the process of still discovering who they are and where they are.

In a way, perhaps we all are still learning and still making discoveries about ourselves. And if we’re not then maybe we should be?

And I’m sure that the world is always a nicer place when people are allowed to be themselves when the way that  they are and the things that they do are of no harm to anyone.

And then … here’s a list of a few gender characteristics taken from the World Health Organisation:

• In the United States (and most other countries), women earn significantly less money than men for similar work
• In Viet Nam, many more men than women smoke, as female smoking has not traditionally been considered appropriate
• In Saudi Arabia men are allowed to drive cars while women are not
• In most of the world, women do more housework than men

There’s no mention of makeup, nylon stockings, suspender belts, skirts, blouses, dresses or high-heeled shoes.

Instead it’s a list of things that seem to be a result of men exercising unfair and unreasonable control over women. Although, I guess the smoking in Viet Nam represents something of an own-goal scored by the men.

And, ok, to be honest, I’ve heard is said that the history of high heeled shoes fall into that category as well. And there are perhaps people that would say the same of stockings and suspender belts.

As I said earlier. It’s a complex business.

But, for myself, I’d definitely rather have the suspender belt and stockings than a pay cut. Though immeasurably better would be the suspender belt, stockings and equal pay for equal work.

Thumbs, nails and hospitals

Wed Feb 15, late afternoon. Ouch. My right thumb is stinging a little. But it looks fine.

The ouch lengthens along with the evening.

More throbbing than sleeping through the night.

7.25 the alarm fulfils its purpose what seems like minutes after I fall asleep.

The thumb hurts. and looks a little red. Shirt buttons become a challenge.

I resolve to visit a doctor if it’s no better at the end of the day. But i don’t want to because tonight I’m out for a meal with Tina.

Early afternoon and still throbbing. Redder. A thin white line appearing around the bottom of the nail.

No answer on Tina’s phone so I send a text to say that I can’t make the evening out. Little knowing what is about to unfold.

A lunchtime walk and I phone my daughter Katie.

Low battery bleeps the phone as we chat.

My thumb’s a bit sore. Maybe I should visit a & e (accident & emergency in UK national health service speak.

What? with a sore thumb? I sense her grinning.

I buy a snack. Partly because I am hungry. Partly to get change for the hospital car park. just in case.

Mid afternoon a text from Tina ... let me know how you are when you get back

17.45 and it’s very red. And the thin white line is no longer so thin.

A&E seems over the top, but I drive close by the NHS walk-in centre at Upton park hospital. An earlier few minutes with Google told me it’s open until 20.00.

Left at the lights instead of the usual straight on.

The pay and display meter says parking is free after 18.00 and it’s past 18.15. small mercies.

The doors open and in I walk.

OMG ... there are loads and loads of people here.

I multiply the number of people by an optimistic 10 minutes and come up with something later than 20.00.

I wave my thumb at the receptionist.

We aren’t making any new appointments tonight. But the triage nurse will see you and offer advice.

Sitting I look around at the people.

All ages and races.

18.35 or so and the triage nurse is looking at my thumb.

That must be painful.

I nod.

name. Date of birth. GP (family doctor). What happened?

I think you should go to A&E tonight.

And so ... Wexham park hospital it is.

A ten minute drive.

The car park isn’t free at any time. But at least there are spaces.

The door opens. Not many people.

I tell the receptionist my date of birth and name. She can work out the rest.

Any existing medical conditions? Taking any medication? Any allergies?

Please take a seat.

19:05.

You can see the doctor in the urgent care centre. Out the door and left.

I take the folder with me and hunt out the urgent care centre.

About 9 people in the waiting room.

Now there are ten.

But some are together so maybe not really so many.

Almost 19.15 and the nurse at reception calls me over. Takes the red folder. Runs through the litany and confirms everything.

There are four patients ahead of you, so you may need to wait a while.

In my head I’m thinking ... well ... maybe 20.00?

The doctor calls people out. They come back and sit around again.

Two young guys and a girl. One of the guys goes with the doctor.

A few minutes later he gets back ... has to go for an x-ray and come back.

They disappear.

I wait.

Thumb quietly throbs.

Redder. Whiter.

They arrive back.

19.45 and there are still 4 people ahead of me.

Everyone looks well happy says the x-rayed man.

Everyone smiles and looks well happy for a few seconds.

The hand on the wall clock moves ever onwards.

The girl sitting across to the left has nicely painted red nails and nice black heeled shoes. I notice things like that these days.

Two middle aged people arrive.

Then two younger people. She has nails that are a lovely shade of pink. Flat shoes. Nice black lace ribbon near the toes.

The nurse calls them each in turn.

The sign reads patients might not be seen in the same order that they arrive.

20.40 ...  and my name is called. I wasn’t expecting to be called before the red-nailed lady.

The doctor shakes hands and then notices I was actually offering my thumb as an exhibit.

The litany again. Name, date of birth ....

That looks painful.

I nod.

Smiling to myself ... maybe I could be a doctor?

It needs cleaning out and antibiotics.

Will it stop hurting after that? I ask.

He reassures me.

Follow me.

I follow him.

Retracing steps back to A&E.

The place is crowded.

Take a seat.

20.45.

Minutes later he comes back in and takes me to the inner sanctum.

I sit in a cubicle. No need for the curtains to be drawn.

He gets a nurse and exhibits my thumb. And explains what is needed.

They disappear.

I wait.

The cubicle has seen better days.

The floor needs sweeping.

MIAMI patients only says the sign on the wall.

I have no idea what a MIAMI means. Except I’m sure it has nothing to do with Miami.

I sit and wait.

Opposite a man laying on a bed asks no one in particular why he is being ignored and calls at passing nurses.

Once in a while someone asks him what he wants.

A drink.

But he is categorised as nil by mouth. So he gets no water.

But keeps on asking.

I look at the signs.

Everyone should have a GP.

Curtain closed? Think! Privacy and dignity.

A twenty-something  girl in another cubicle has blonde, green and brown hair.

The nurse visits with another nurse and exhibits my thumb. They smile but say nothing to me.

It feels like being a Franz Kafka kind of character.

A doctor arrives.

We repeat the litany.

He look as at my exhibit.

And mentions infection. Intravenous antibiotics. Overnight stay. Plastics. Drainage. Thumb nail removal. X-rays. Bone infection.

I take the yellow sheet of paper and follow the blue squares in the floor.

Another receptionist. I hand over the sheet and confirm my identity.

I take a seat and wait.

The thirsty man is wheeled in to the x-ray room.

Moments later he reappears.

A young guy takes his turn.

Then, just a few minutes later it’s me.

I make a ducks head sort of shape with mu hand. The red light lines up on my thumb.

Zap.

Reshape my hand. Line up.

Zap.

I follow the blue squares back towards A&E.

The thirsty man seems to be no longer nil by mouth.

I take a seat.

21.08 my phone rings. It’ Katie.

Low battery beeps.

I explain where I am.  We talk.

The doctor arrives so I have to say goodbye.

He escorts me back to MIAMI.

Spreads paper towelling onto the trolley bed and asks me to lie down.

The girl with the coloured hair is still opposite.

The no longer thirsty man.

An elderly lady who cries out occasionally.

I wait.

Receiving health care involves patience.

A single strand of cobweb dangles loosely from the ceiling.

There’s a hole in the wall blocked up with some temporary filler.

Time passes.

I phone Katie.

my phone tells  me it needs feeding.

I think of the cats at home.

The doctor returns.

Sweater comes off. Right shirt sleeve rolls up.

I know that the sight of my own blood leaking from my body makes my blood pressure drop ... quite dramatically.

I look the other way and hardly feel a thing as the needle penetrates just below the elbow joint.

Moments later he has a phial of red fluid and I have a cannula and intravenous saline.

A nurse comes and mentions ward 3 and then goes.

Another nurse arrives with antibiotics.

Do you have a pen and some paper?

Of course.

Please could you write down a phone number for me?

Before the phone expires on me I read out Sarah’s number so I can at least try from a landline later.

The antibiotics make their way into my vein and I’m asked to sit in a wheelchair and await transportation to Ward 3.

I phone Sarah ... battery needs charging ... she says that she’ll phone A&E.

I sit and wait.

A phone rings. And rings. And rings.

Nurses and doctors busily move around.

The phone rings. And rings. And rings.

And rings. And rings.

And no one answers.

I’m wheeled along to Ward 3, though I would have been happy to walk.

Ward 3 is fairly quiet at this time of night. A bed is being prepared for me as I wait in the chair.

Name ... date of birth ...

Can I use the phone?

Well ...

A patient says I’m welcome to use his mobile ... but there’s no signal.

I use the landline.

Sarah phones back and I explain what’s happening.

The bed is ready so I’m escorted to bed 11 in Ward 2 SS (short stay).

The man in bed 10 nods hello. Everyone else is asleep.

Actually there are only 4 beds on this side of the ward and one of them is empty.

The thought of car parking fees crosses my mind ... but I’ll worry about that tomorrow.

Pyjamas. The nurse disappears a moment and hands me some. The bottoms and tops don’t match ... but I’m not too worried about that ... if I’d had a handbag with me though who knows J

The curtains close and I begin to get changed.

My toe nails are polished red. And the floor is cold.

I’m not worried about the red nails. If people ask questions then I’m happy to share the answers. Having said that ... I’m also aware that my red nails might cause people heartache ... so I keep my socks on ... if asked to take them off then people will get to see my nails without me forcing the sight upon them.

The nurse arrives back. Katie’s on the phone. We chat a while then back to the bed.

Some pain killers. A wrist band with my name, NHS number, hospital number, date of birth ... A sling so I can have my arm up in the air while I sleep.

Sleep ... a little restless but not bad.

5:30 or so and lights go on.

Antibiotics time.

The nurse wonders why on earth the cannula is on the same arm as the infected thumb. It would have been a lot easier to not have to unhook the sling and take it off.

A new patient arrives in bed 9.

Bed 10 chats a bit with bed 12 as medications are passed round the ward.

6:30 and breakfast orders. I opt for toast and coffee. Bed 11 wonders about a full English, but settles for cereal.

It arrives at about 7:00 with marmalade.

The beds are made.

How are you today? says one nurse to the other.

Comme ci comme ça.

Ahh .. Parlez vous Français

Well ... no.

A man from plastic surgery comes to say hello.

The nail’s going to have to go. It’ll happen in the operating theatre. Local anaesthetic ... injections here and here. An arrow is drawn in my arm ... thick black ink ... pointing towards the problem thumb. Makes me smile. Only an idiot would take of the wrong thumb nail. And I’ll be awake as well. I might need to stay the night in hospital.

8:55 ... can I use the phone to call work? No problem.

A colleague of the man from plastics looks at my thumb. Probably won’t need to stay the night in hospital.

Sitting in the chair at the side of the bed.

Chatting a little.

Bed 10 thinks the sling looks a little like a piece of armour from a star wars storm trooper.

One of the nurses is from Mauritius and does parlez Français. He explains that about half the people in Mauritius support Manchester United. The other half go for Liverpool.

The other patients on the ward are older than I am, and all I have is a sore thumb.

I know that if left untreated the thumb could develop into a debilitating thing and could get quite serious. But I expect it to get better. And I don’t have a problem in getting out of bed, or walking, or passing urine.

Hospitals are sobering places. Especially with age. Sometimes the passing of time brings good things. But in the shadows lurk things that aren’t so good.

Time passes.

Consent forms to sign with an explanation of risks and benefits.

A nurse arrives with a 2 nighties ... can’t wear PJ’s in the operating theatre. I put one on the front and another at the back so my modesty can be preserved J

11: 20 and the trolley bed arrives.

Can I manage it by myself? I do.

The porter pushes the trolley and we’re accompanied by the nurse from Mauritius who admires my sling ... its purple ... wow .. if you don’t like the surgeon ... wow ... especially if he’s a Liverpool supporter. As well as being purple it’s also made of foam ... so I decide not to use it as a weapon.

The sign on the door says we can’t get through ... so we take a detour.

At the entrance to the theatre ... name ... date of birth ... do I have a black arrow?

I need a pee ... and I’m escorted to the loo.

Back onto the trolley.

The surgeon arrives and tells me all about me.

And explains what he’s going to do and why.

Maybe I’ll have to spend the night in hospital.

The anaesthetist arrives.

I look the other way as the needle does it’s work.

The trolley is wheeled in.

Paperwork is checked and corrected.

They wonder why the cannula isn’t on the other arm. And also the wrist identity strap.

The cannula stays. The strap is cut off and fastened to my other wrist.

Stuff is painted on my hand.

I look the other way.

The anaesthetist offers to distract me and we chat as the work begins.

Let us know if it hurts.

I promise to let them know.

It’s an odd feeling ... I can feel pulling and cutting ... but it doesn’t hurt.

We talk about Frankfurt, skiing, snowboarding and the fact that we’ve both fainted at the sight of our own blood.

It’s done ... and I’m invited ... recommended ... to look at the results.

Thumb ... no nail.

Raw and red. But surreal. It looks as though it should be hurting.

The infection was at the point where the nail grows. They expect it to grow again ... but maybe not quite the way it used to. I’ll have to wait and see on that one.

Bandages and sticking plaster.

I don’t need to stay the night ... but need to call in on Monday to get it checked out.

If I feel feverish or it hurts a lot over the weekend I need to get back to the A&E department. The surgeon is on call and says he’ll head straight back to check it out.

Wheeled to the recovery room.

The nurse there says I look familiar.

Another chats. We talk about the thumb and how it might have got infected. He mentions that computer keyboards can harbour a lot of nasty things. And that some research had discovered nastier things lurking on the top of cans of soft drinks than are found in the average toilets.

The first nurse goes hunting for the paperwork.

In the background I hear her phoning ward 3 asking if they are expecting me back.

I hope they are. They’ve got my clothes. And my wallet.

I lay on the trolley. Legs crossed.

Sorry ... I’ll have to ask you to uncross your legs whilst your here. Blood clots.

I uncross my legs.

Another porter and another nurse to accompany me back to Ward 3 SS.

The door is closed. The porter manages to open it. The sign ... visible only from the other side ... says the door isn’t working and to take a detour.

Which bed? Asks the porter.

Probably the empty one smiles the nurse.

That’s the one I came from say I.

Lunch is a baked potato, cheese and baked beans. Ice cream. Coffee.

More antibiotics.

Visiting time ... and I’m pleasantly surprised when Katie walks in. I had no idea she’d be visiting.

The cannula is removed and strip of gauze taped over where it was.

I’m good to go ... with my pack of antibiotics and pain killers and appointment card for Monday.

The nurse says that security will let me out of the car park for free.

And there we go.

I haven’t needed the pain killers. Still taking the antibiotics. And on Monday things were looking good.

All in all ...

The waiting was sometimes tedious ... but never very long really.

Everyone was helpful and courteous.

Lots of people were friendly.

Everyone helpful.

Some people need to be better at answering telephones.

It’s interesting how difficult it is to know what might happen next ... it changes as time passes. But I guess that’s actually a good thing.

It’s nice that at no time did I have to think about insurance or costs.

People seemed efficient ... and the process actually went quickly and smoothly all things considered.

The food is unexciting. But ... I have no complaints.

The nail ... I’ll let you know about that.

And finally, some possibilities for the meaning of MIAMI:

• MIAMI Money Is A Major Issue (music CD) 
• MIAMI Metoprolol in Acute Myocardial Infarction 
• MIAMI Marrow Isolated Adult Multilineage Inducible (biology; cells) 
• MIAMI Microwave Ice Accretion Measurement Instrument 
• MIAMI Modem-Based Internet for Amiga (TCP/IP implementation for Amiga) 
• MIAMI Mafia Is After Me! I...