Still going strong.

#NaNoWriMo is nearing its end for this year. Not a lot of days left and still working on it daily. Not adding a lot of words, the first draft has been completed after all, but editing a few scenes or chapters every day. Only edited a few scenes this morning, too tired and horrible headache. Still did a little before leaving for work. Now, I am home again for a short period, and longing for my bed. Need to pick youngest up from school soon, though.

And after all that, tea will need preparing, the bins need to be put outside and perhaps then I can go to bed. I will share another little excerpt today, one of the stresses of general practice. One that all GPs hate, the dreaded complaint.

And here is what happened prior to the complaint, the consultation with the patient who complained:

After Moira leaves, I spot another three ring backs arrived. I’m running more than a quarter of an hour behind and I need to catch up. The receptionists would alert me if anything urgent had popped up. I leave the ring backs for now and buzz for the next patient.

Immediately an instant message pops up on the screen from Elaine, “Be careful with this patient, Dr J. He was very agitated and verbally aggressive in the waiting area.”

Forty-three-year-old Darren walks in without knocking, his face like thunder, “This is absolutely ridiculous. Do you think I have all the time in the world? For me, time is money. If I take time off to see the doctor, I don’t get paid and I expect to be seen on time. The service you provide here is completely atrocious. This is unacceptable and I should go to my member of parliament over this.” Darren’s demeanour is such that images of cartoon characters with steam coming out of their ears come to mind.

No ‘hello’ or even giving me a chance to apologise first. No, Darren steamrolls his way into my room and airs his anger. He remained standing while he spoke, his posture aggressive and looming over me, an attempt to intimidate me further. Now he sits down, sliding down on the chair, his face still like thunder.

How can I save the situation? “I’m genuinely sorry to keep you waiting. You are absolutely right that it is unacceptable to keep you waiting for such a long time and I take full responsibility for that. I apologise sincerely.” I take a breath, “So what can I do for you today?” and hope my apology will calm him down a bit, the fact I agree it is unacceptable may take the wind from his sails.

“Well, I don’t really have the time for this, but now I’m here,” he takes out a piece of paper with writing on it. “First of all, I have an ingrowing toenail and want some antibiotics for that. Second, I have this nasty cough for the last week and need antibiotics to clear that. And the third problem is this rash on my leg that has been bothering me for a few weeks. It’s itchy and you need to do something about that.”

How should I deal with this? At the surgery, we maintain a simple rule, One appointment, One patient, One problem. Instead, Darren expects me to deal with three problems at the same time and I am already running late. Every problem deserves their own proper attention and trying to force three problems within one appointment may make this difficult. 

I try to explain to Darren that we usually only allow one problem per appointment to allow it to get the attention it deserves, but I notice how he only gets more agitated and instead inform him we will deal with his problems today.

When I check his toenail, the nail is indeed growing in slightly, but it is not infected and does not require any treatment at the moment, “Daily bathing of the toe will help to avoid this getting infected. Just ten minutes in warm water and soaking it before dabbing it dry. If the toe does get infected after all, then please come back to have it checked.”

Darren sits up a little straighter, “Well that’s a bloody waste of time. I need you to give me some antibiotics for this now and make the wait worth my time. I haven’t got time to come back if it gets worse, I need this sorting out now.”

Next, we turn our attention to his cough. Darren doesn’t cough up any phlegm and has no temperature. His chest is clear on examination. Again there is no reason to prescribe antibiotics and this would be bad practice.

“You’re bloody no good. You call yourself a doctor?” Darren sits up even straighter and leans forward a little.

Darren’s last problem is the itchy rash on his leg. So far, he has not tried anything for it, instead wants me to sort the problem for him. On examination there is mild eczema and I advise him to use a moisturiser for it. When I offer to write a prescription, Darren refuses and leans forward more, invading my personal space as he does,  “You’re  a bloody disgrace, you’ve kept me waiting for half an hour and done nothing for me.” Darren stands up and struts out of the room, slamming the door behind him.

I let out a deep breath of relief and wonder how I could have handled that better. Hopefully, his rants are sufficient for him, but I fear more is to follow. Is this job even worth it?

A few hours later, after a message from the Practice Manager:

Before I leave for my visits, I take more prescriptions and paperwork to reception and then walk upstairs, use the bathroom and go to see the practice manager as she requested earlier. My stomach is grumbling, but it will need to wait for now. 

Although I’m not sure what she needs to talk to me about, I suspect something is wrong as she often only asks to speak to us if a complaint has been received. After knocking on her door and entering, Claire greets me, “Busy day today?”

When I confirm it has been rather busy, Claire gets to the point, “Sorry, I’m not going to make your day any better. I received a complaint about you this morning. A patient you consulted this morning complains you were rude to him after already having left him waiting for over half an hour and then neglecting to give him the appropriate treatment for his problems.”

Three guesses who that complaint is from. Why on earth do I still try? Whatever we do, it is never good enough. Sometimes it seems better to just say to a patient, you are right, I’m a bad doctor and I will put in my resignation right now. That is not actually true though. The majority of patients are very grateful for what we do, it is just patients like Darren, who make you doubt your conviction to your job. After reading his letter of complaint, I go over the consultation in my mind. Had I been rude? I’m sure I remained civil throughout the consultation, even when he called me all sort of names. If anyone was rude, I consider it to be Darren, but maybe I’m in the wrong here after all. How one person sees a situation is not always how another person sees it. right?

Should I have given in to Darren’s pressure to prescribe antibiotics? Although it might have partially avoided the complaint, it would have been bad practice. Giving antibiotics when the situation does not require them, leads to bacteria developing a resistance to the antibiotics. These bacteria no longer respond to antibiotics and suddenly become killers. No, I’m not willing to enable this behaviour, complaint or no complaint.

Perhaps I should have been more compliant and not informed Darren we only allow one problem per consultation. However, patient education is important and if a patient is not aware of the fact he is supposed to book a longer appointment if he brings more than one problem to a consultation, he will continue to bring several complaints to one appointment in the future, ‘to save time’. In fact, it leads exactly to what he also complained about, having had to wait for too long a period. Half an hour he had mentioned. I was certain it was less than half an hour. Unless, of course, Darren included the wait from the time he arrived at the surgery to his appointment time and the quarter of an hour he had to wait after his appointment time.

At the moment my mood has plummeted, I’m hungry and there is still a lot of work ahead of me today. Now, I will first need to get ready for the visits and deal with the work during the rest of the afternoon. And when I have a moment, I will need to respond to that complaint. Dutifully apologise for any upset I have caused him and for the rude behaviour I was not aware I displayed. Really, why do I still try?

Joni

Day 24 of #NaNoWriMo and still working on it daily.

A quick update on the progress of #nanowrimo2018 again. Today I have not done much other than editing 'Diary of a Female GP' and working on my assessment for the writing course I am doing.

No excerpt from me today I'm afraid, other than the assessment I already published earlier today.

Editing the book, has brought another 388 words along. And here is the picture to go with it.

Joni.

Time for course work. 'The Hidden Village' by Joni Martins.

As you may be aware, I'm currently enrolled in a free writing course at the University of Iowa, entitled Stories of Place: Writing and the Natural World. 

You can find the course here (https://iowa.novoed.com/#!/courses/stories-of-place-iwp/flyer) if you are interested as it runs from 15 November to 31 December as an instructor-led course, but the course can be done at your own pace until 15 March 2019.

Below is my submission and I hope you like it.

#######

The ‘Hidden Village’

When I was a young girl, a young teenager, my grandparents lent me a book to read. The book was called ‘Het Geheime Dorp’ and told the story of a hidden village within a forest in the Netherlands during World War II. The thing which made the book so special for me was that this story was about real-life occurrences and took place just around the corner from where I lived. I really enjoyed reading this book as it brought the stories of the resistance and the refugees to life in a place I could relate to. If you ever read Anne Frank’s diary, you know where I am coming from on this.

Nowadays, a museum has been built in the area the village was and I will tell you about the history of the hidden village first to help you relate to this piece of nature as I do.

* * *

Between April 1943 and November 1944, between eighty and one hundred and twenty refugees lived hidden in the forest near Nunspeet, a Dutch village just east of the water in the middle of the Netherlands. Although the refugees initially lived in a tent and a container, members of the resistance built underground cabins in sections of the forest later.

Edouard von Baumhauer, Opa (grandpa) Bakker and his with Tante (auntie) Cor were instrumental in the running of the village and bringing food and supplies. Amongst those living in ‘Het Verscholen Dorp’, the Hidden Village in English, were many Jews, allied airmen, a German deserter, a Russian and a Pole. In total, ten cabins were erected to house eight to ten people each.

The village lay hidden deep in the woods, but not far from the home of the Vos family, who allowed the refugees access to their water pump and their home also acted as storage for food for the Hidden Village. A special communication system was in place to inform the refugees whether it was safe to come near the house. If it was unsafe, the Vos family would hang a piece of fabric on a tree. If they considered it to be unsafe the entire night, they would leave their guard dog outside, who would bark as soon as it noticed movement. This acted as a signal to tell the refugees to return to the Hidden Village instead. Eventually, a water pump was placed closer to the village.

 The access to medical and dental care was severely limited. This consisted of the presence of a medical student and a dentist amongst the refugees. If hospital treatment was required, the patient needed to be carried to a larger road, to be picked up by the ambulance there and taken to the hospital.

The sections of the forest on which the cabins were placed, were separated by fire corridors and it was strictly forbidden to visit the other cabins or the water pump during the daytime to avoid detection. The refugees were also expected to remain in absolute silence, something which was especially difficult for the children.

Their days consisted of crafting, reading, preparing meals and playing games and a few students provided the children with education. A survivor mentioned he could not remember a time when he had been bored there as a child.

When complacency set in as everything progressed so well, a member of the resistance made a film about life in the village. On a search of his home, the Germans confiscated this movie, but fortunately, something happened to the film and it no longer could be viewed. Some say it was a German who foolishly opened the container outside a dark room, others tell how a member of the resistance caused the error at the lab the film went to be examined. Discovery of the film led to the refugees being sent to other addresses in the area temporarily.

On the 29th of October 1944, two members of the SS hunted in the forest when they heard sounds of sawing and woodcutting. As they investigated this, they noticed a boy on his way to collect water. A survivor remembers hearing a loud shout, “Raus du Jude, raus raus!” (Get out Jew, get out, get out!) The members of the SS fired a few warning shots and a large group of refugees was able to escape during this time. The boy was allowed to escape to allow the SS-ers to get reinforcements from a camp nearby.

On their return, the majority of the refugees had escaped and hidden elsewhere, but still, they threw hand grenades in the cabins, demolishing them in the process. The soldiers had expected more resistance. During a search of the area, eight refugees were caught, amongst which a six-year-old boy. Two refugees faced the firing squad at the nearby camp, the other six were forced to walk back to the village, dig a hole and were shot there. On the site of the village now stands a monument in memory of these eight.

Three cabins have been rebuilt in the section where the water pump once stood. These are in memory of those who lived in the village during the war. Opa Bakker was arrested in February 1945 and shot with forty-seven other members of the resistance. His wife survived the war as did Edouard von Baumhauer. All people who helped to support and hide the refugees were honoured after the war.

* * *

 

Now you know the back story of this place in the forests near where I grew up, you may understand why this has made such an impression on a young teenager. Many a time I would cycle there and visit the camp when I was a little older. I would grab my bike and dog and cycle over, my dog running alongside the bike. She was a large dog, a Rhodesian Ridgeback. We would ride down the road in front of our house and at the end of the road, the forest already lay waiting. There we would take a left and continue our route along the edge of the forest. A lovely cycle path in the shade of the trees. The smells of the forest would surround me as I inhaled, the fresh pine needles, the oaks and the mulch underneath them.

We would ride further and cross over the motorway and then take a right on the large road into the forest. This road was tarmacked and soon there would be a sandy lane off towards the left. We would follow the cyclepath next to the lane, heather to our right with trees behind it and trees on our right. After a while, we would pass the ‘Waschkolk’ on our right. A small area of water where shepherds used to wash their sheep. On different days we would go for walks here, often before going to work in the morning. The lane continued and once we reached the Tongerenseweg, we took a left towards Huize Pas-Op, once the home of the Vos family. Once we passed the house, we took the first lane to the right and continued further. It was a long journey, but well worth the effort and ideal when you brought a packed lunch.

Near the site of the Hidden Village, I would park my bike against a tree and lock it, then grab my bag and explore the site. It was really amazing, hidden underground, with the roofs about at ground level, were huts which during the war would have housed eight to ten people. Along one side of the hut, bunk beds would be placed, all made of wood. Two beds above each other, four next to each other. A total of eight per hut. A table stood in the middle of the cabin. If I touched the wood around me, the memories were nearly palpable. Even though I knew these were not the original cabins, the memory still lingered in the woods and a lump would block my throat. A heaviness sat on my chest as I remembered those who suffered during the war, those who died and those who lost so much.

* * *

Soon, I hope to visit the site again, to show my daughter this amazing piece of history. As she loved the visit to the Battlefields in High School, I’m certain she will appreciate this trip too.

* * *

Nowadays the area is peaceful, you hear the birds sing and smell the fresh air around you. But we should never forget the atrocities the war brought. The devastation, but also the courage and solidarity of many who risked their lives to save others.  Would I ever be brave enough to do something like that? Although I fantasised I would as I read the book, I now realise I would possibly be too much of a coward.

Hat off to people like Edouard von Baumhauer, Opa Bakker and Tante Cor! May we never forget.

Joni Martins.

(Outside of the story, my approach is the way I like to write if describing things, an introduction, some background, the main, a discussion and a conclusion. This most likely stems from the time I used to write reports as part of my job)

Missed my daily update yesterday. Day 23 of #nanowrimo2018

I missed my daily update on the journey yesterday. Time was that limited I did not have a chance to report on the progress. Still managed to write a few words, 549 to be exact, but no chance to do anything other than that.

Since I started a new job on Monday, somewhat unexpected as I only was roped in to do this job a week ago, I have had very little time to write.

Today even less so, only 185 words, bringing the total to 90866. That said, I wrote the epilogue yesterday and only edited two chapters today. 186 words is not bad for only editing.

The excerpt today is the epilogue, hope it gives rise to some thought.

Surely the life of a GP must have gotten easier by now? If that is the thought crossing your mind, I’m afraid you’re mistaken. 
“But how about the promises the government made in recent years? 5000 extra GPs. That must have helped.”
Again, you’re mistaken. The government made this promise, one that was said to take place over a number of years. To be honest, I’m unsure where they will get the GPs from. So far, more and more GPs retire. Some retire early, like Dr J did, some retire when they really can’t go on any longer. Dr J knows one GP still going strong who is well into his nineties. Many more GPs are expected to retire over the coming years and the 5000 promised GPs may not be enough to cover those who are leaving. But where will those new GPs come from? It is difficult to see how these will be found, from abroad? But wasn’t that partially what Brexit was about? No longer recruiting from and allowing people to settle in the UK from abroad? Or is there some hidden lab where they are creating test tube GPs?
There have been voices raised about accelerated training. But how good would that training be? Would that still guarantee good care?
The honest answer is that I don‘t know what will happen or whether the government will be able to deliver on their promises or whether the work pressures will continue to increase as they are now.
What I do know is that John, Dr J’s husband, is still working. His partner retired, leaving him the only partner in the practice and left to care for over six thousand patients. John has regular locums and a salaried doctor working for him. However, if one of the doctors is ill, he will need to work harder to pick up the slack or even come in during his holiday. Only a few weeks ago, he needed to come into work every single day of his week holiday. This can’t go on. Everyone needs some down-time to be able to function properly. So far, he is doing really well and coping admirably. But, how long can this continue? How long will it remain safe to practise under this continuous pressure?
No one knows. I only recognise things need to improve if primary care is expected to continue to provide the best care to their patients. That is the thing which is most important to those working in primary care. Often they will neglect themselves to be able to give their patients their all. We can only hope that more doctors decide to become GPs and more help is put in place by the government. Simply piling on more responsibilities and requirements onto GPs and not providing the resources needed to deal with these is not something which will work. At least, not in the long run.

I hope you have enjoyed this little peek behind the scenes into the life of one GP and please bear this in mind if you go to see your doctor and he or she runs a little behind schedule. Possibly your doctor has been dealing with a complex problem and it might be you who needs a little more time the next time.

Joni

#NaNoWriMo update day 21.

#nanowrimo2018 day 21 brings another update. It appears the only way I'll be able to write on a daily basis (other than work-related) is to get up early every day and write before my working day. This is one of the drawbacks a lot of my fellow authors will suffer with. To find a way to mesh together the day job and the job as an author. Not many of us will have been in the position I was. To be able to write all day long if we wish and not be worried about any other jobs that might need doing.

From a retired person, I have become part of the world of worker bees again within a period of a week. Now I spend my days in a similar way to when I was not retired yet. I get up at 4 am, do the housework. Instead of leaving for work at around half-past six and doing work before the work day, I now spend an hour or more on my writing and then set off to go to the day job. At least, that is how I have done it over the last few days.

Does it work? It seems to. This morning I wrote another 1866 words for 'Diary of a Female GP' and the total is now 89954 words. All that is left now is to write the epilogue and the back matter, edit the book and export it to Word. Then I need to validate my word count and I wonder how the yWriter 6 word count will hold up against that on the NaNoWriMo website.

Another small excerpt of the book in progress can be found below and I hope you'll enjoy it.

When I join John and the kids in the living room, I reflect on the amount of time I spent with them this weekend. This was an extremely limited amount of time and it makes me feel guilty. These days I only see them at breakfast and teatime and only if I get home before they go to bed. This in turn makes the sensation surface that I am a neglectful mother and am doing them a disservice. Should I not put their needs first? But then, shouldn't I put my patient's needs first too? When I think about it, I realise my kids, husband and patients always do come first. The only person who is an afterthought is me. Not for my kids and husband, but for me. 
Fortunately, the kids seem happy and content. Sometimes they complain when I can't be there to do things, but generally the kids appear to be content with how everything is. All four of the children do well in school, make friends well and we are extremely lucky, the kids behave well too.
At the moment they are all absorbed in playing computer games. John is playing on the PlayStation and none of them appear to have noticed my entrance too much. After taking a seat on the couch, I pick up the Kindle and read further in the book I was reading.

Soon it is half-past seven. Time to go upstairs and get ready for bed. Tomorrow will be another early day, my alarm is set for a quarter to four again as always on a workday. At least I only need to work two hours tomorrow. The rest of the day will consist of household chores, shopping and the school run. It will be another start of another week. The same old, same old. New patients, new problems but more of the same anyway. There will be more colds and sniffles, earaches, tummyaches, joint and skin problems. The benefit of General Practice is seeing a variety of problems and a variety of patients. You also are able to see entire families and watch them grow up and grow older. This also means you see the same patients time and time again and they become your friends in a way. And when they get older, the inevitable will happen. Eventually the people you have cared for over the years will die and you lose a friend. Although we learn to not get too attached through time, this will bring the occasional tear to our eyes too. We are not machines after all.

But now it is time to get upstairs, get changed and go to bed. I need to get enough sleep to be able to deal with the coming week.

Joni

Nearly there, #nanowrimo2018 day 20

Today I got up at four, did the housework and some writing afterwards. I need to get ready for work soon and I wanted to have a chance to get some writing done. Nearly there! Only one more chapter left to write and the back matter, then the first draft is done. If I have a chance, I will do a first edit before exporting 'Diary of a Female GP' from yWriter 6 to word and validate the win. Not much left now and should be able to get there in time.
Added words today: 1685
Total words so far (this is a funny one and I'm not sure how I managed to get this number) is 88088.

My process for today is down below, and today I have a short excerpt of the work in process, unedited. Hope you like it.

Now it is time to summarise a few more notes. By now it is already half-past nine and I resolve to summarise notes until twelve. In this period of time I only manage to process another ten sets of notes, one set taking nearly an hour. This patient is a diabetic. Details of last annual review need to be added to the electronic records and a new recall date set for the next review. She also suffers with asthma, the last review over two years ago and the patient uses inhalers. This means the patient should be seen on an annual basis, she must have slipped the net or not attended for her review when requested. On the patient's notes, I set a date for next month for the review and I send a task to the receptionist who sends out the letters for recalls to alert her. The patient's last cervical smear was last year and it was normal, she needs another smear in two years as she is under fifty years old. All these details I put on the electronic notes too. A history of hypertension, high blood pressure, is also recorded in the notes, an annual review for this not obvious in the notes. Perhaps as this will be done at the same time as the diabetic check anyway. The date I put for recall for the hypertension review, is the same date as for the diabetic review. The same goes for the date for the patient's annual CHD (chronic heart disease) review, she suffered a heart attack two years ago.
When I finally put away the final set of notes for today, I'm quite pleased with myself having managed fifteen sets of notes, it is twelve. Still, it is only a start. We have a bit of a backlog at the moment after a recent influx of new patients. John is correct in saying we need to get more people involved with the summarising. Perhaps we can train our staff up to do this for us.

Joni

#NaNoWriMo2018 day 19

The 19th day of my #nanowrimo2018 journey is a slow one. Not done much writing at all. At least not for my books.
Today I've started a new job and this has kept me away from this hobby of mine. Only 409 words done and it is near enough bedtime. So, not much of an update today. Nothing much worth putting down as an excerpt either. At least, not from what I've written today. (total 86403 words)

Hopefully (I can dream, can't I?) I'll have more of a chance tomorrow. Have a good evening everyone!

Joni.

#NaNoWriMo day 18, getting close to the end.

On the eighteenth day of #nanowrimo2018, I have written another 2012 words, bringing the total up to 85994. I now hope I'll manage to get the total to around 90000 and there are only a few more chapters left before I can start the real editing process. Once this is done, I will need to export the project from yWriter 6 and change it to a Word document and check it against the website. Apparently, there are likely to be differences between one word count and the other.

So, the end of 'Diary of a Female GP' is in sight. Still, there is no guarantee I will be able to finish it by the end of this month. I still aim to do so, but am worried work will interfere with my ability to do so. At the moment, it feels like an axe is hanging over my neck, edging ever closer.

I hope you will enjoy today's excerpt from the work in progress. This is actually also a recipe for a lovely Chinese meal if you ever wanted to try it.

At half-past four, I shut down the computer and put it away. Today Chinese is on the menu and this means I need to make a lot of preparations. These preparations start with setting the table for our meal.
First, I break three eggs for an omelette, adding parsley and pepper. While that is cooking, I cut an onion for the satay sauce I make.
The omelette is done, and I put it to the side, taking out a saucepan and frying the onions until they are soft. Then I add a small jar of crunchy peanut butter and stir it until it is mixed. Now, I add ground ginger, coriander, garlic powder, cumin, curry and turmeric. I take a jar of sambal oelek from the fridge, this is a chilli pepper paste, and add two teaspoons to the mixture and now also add three teaspoons of soft brown sugar. This is stirred for a while longer and now milk is added until a smooth sauce emerges. The satay sauce is nearly ready and I add a little soy sauce and leave the sauce to heat a while longer before putting it to the side.
The next job is to put a large pan of water on the stove and bring it to the boil. Once it boils, I will add one nest of medium egg noodles per person to the water and allow it to soften and get ready. But in the meantime, I have a chance to cut the remaining ingredients for the bami goreng, which is like egg fried noodles.
Starting with spring onions, I cut those in thin slices, then cut a carrot in small cubes. A small pack of cooked ham is cut in small squares too and the omelette is now cut in small strips. After placing the noodles to the side, I turn my attention to marinading the chicken for the satay. The marinade I use consists of soy sauce, cumin, coriander, garlic, turmeric, curry, ginger and sambal. The chicken is cut in small cubes and stirred into the marinade to fully cover the meat and then left for ten minutes.
Now, I get another three eggs and get them ready for a second omelette. This omelette will be egg foo yung. The version I make is called foo yung hai, which is the same in a tomato sauce. For the omelette, I also need a filling and I cut two more spring onions, a few button mushrooms and place them in a bowl. Cold water prawns will also be added when I prepare the omelette later on.
The tomato sauce is easy to make. One mug of bouillon is put in a saucepan and brought to the boil, I add four tablespoons of tomato ketchup and next; I add ginger powder, cumin and a little garlic powder and a teaspoon of sambal. Again three teaspoons of soft brown sugar go into this sauce too and this is mixed until a smooth sauce appears. The sauce is still rather thin by now and to bind it, two teaspoons of cornflour are mixed with a little water and then poured and stirred into the sauce until it thickens. This is put to the side too.
The preparation stages of the food are now over with and I can start cooking now. The satay sauce and tomato sauce are placed on two smaller burners and put on a low heat, stirring occasionally. Two woks are added to the larger burners and with oil added, I fry the marinated chicken on a medium heat. To the other wok I add the cut spring onions, carrots, ham and omelette and also some petit pois. On top of this, I add cumin, coriander, garlic, turmeric, curry, ginger and sambal and I stir-fry this for a few minutes. After draining the noodles, I add these to the mixture and continue to stir-fry the mix. The satay is not forgotten about and I stir-fry this at the same time. 
Once the bami goreng (egg fried noodles) are ready, I place the wok on the table ready for the family. It will remain hot for long enough to allow me to use the now vacant burner to prepare the foo yung hai. To do this, I first fry the spring onions, mushrooms and cold water prawns and add a little pepper and parsley. When they are ready, I place them to the side and prepare the omelette, adding the mixture to it while it is not yet set. Once this is ready, I fold over the omelette and place it in a serving bowl, then pour the tomato sauce over it. The satay sauce and the satay meat, I leave this in separate pieces these days rather than placing them on a skewer, also are added to the table, and it is time to call the family to the kitchen.

Joni.

Book Review: The Dead Wake Anthology by Ellie Douglas

Book Review

Basic Details:

Book Title: The Dead Wake Anthology

Subtitle: The Dead Wake Horror Collection Vol 1

Author: Ellie Douglas

Genre: Horror

Part of a series? Yes

Order in series: 1st

Best read after earlier books in series? No

Available: https://www.goodreads.com/book/show/37796906-the-dead-wake-horror-collection-vol-1

Overall score:

I scored this book 4/5

⭐️ ⭐️ ⭐️ ⭐️

Short Summary of the book:

This book is a collection of horror stories, generally zombie-like creatures sprouting up in the stories. It is a great read for lovers of zombie stories and the author’s style of writing is great. The genre does not really appeal to me, but the way the author has written the stories, made me want to keep turning the page after all. Even if I did not really like the goriness of the stories.

What I liked about the book:

I particularly liked the author’s writing style, which kept me changing the pages although the genre made we wish the book was finished. This really was a contradiction in feelings as I wanted to know the outcome of the story but didn’t really want to read the story either. Confused? Yes, so was I.

What I didn’t like about the book:

I wasn’t impressed by subject. Zombie stories don’t appeal to me at all.

My favourite bits in the book:

I loved when stories appeared to have a happy ending. But did they really? Sorry, this genre really is not my cup of tea.

My least favourite bits in the book:

I didn’t like the genre but loved the author’s style of writing.

Any further books in the series? Any more planned by this author?

I understand from the vol. 1 part of the title that there will be or are more books in this series.

What books could this be compared to and why?

This book reminded me of no other books I have read so far. As mentioned earlier, this is really not the genre for me.

Recommendation:

In summary, I would recommend this book for the following readers:

Children	No
Young Adult	Yes?
Adult	Yes

If you like Horror and zombie stories this book is the book for you.

If this author would also write different genres of books to horror, I would look forward to reading more books by this author. Horror is, however, really not my cup of tea. But, I loved the author’s style of writing.

Book Description by Author:

Ten utterly gruesome tales, that will disable you. You won’t know what hit you. You will from this day forward sleep with one eye open. Insist that all the lights stay on...always. You will begin a ritual; checking under your bed, inside the closet and double checking your windows. Throw into this the sick and twisted and the utterly crazy humor and your stomach will explode. With some erotica, you’ll be hot and sweaty and wont know which way to run...and you’ll be scared for life. In the best possible way.

About the Author:

I’m Ellie Douglas, and like you, I love horror, everything about horror, the goriest and most gruesome of horrors is the ultimate. I can’t get enough. So much so that I write horror. That need to be graphic, and explicit with my horror scenes makes me stand out. I give what I want to read to others, so now they can enjoy a true horror story.

I’m not all about just being graphic, I also build characters that the readers will love and or hate, so they can feel pulled right inside of the story that they are reading. It gives me so much enjoyment when I hear remarks like, ‘You made me want to puke,’ ‘I have nightmares every damned night –thanks,’ and ‘Quentin Tarantino and Steven King made a baby, YOU!’ when I hear comments like that, I know then I’ve succeeded, that also pushes me into writing more and becoming even better.

I’m fun loving, generous and very mysterious. I enjoy spending time with my family, and have four children to keep the horror writing alive. I enjoy helping others and volunteer my services to help Autistic children, I love cosplay and the chance to dress up as a monster, zombie or some other gritty character is fun, oh so much fun.

I love summer, and well…I hate winter. I live in New Zealand and feel often too far away from all the cool stuff going on in the world. I love helping people all the time. I’ve got my hands dipped in a few things, I write books, but I also make professional book covers for other authors, I also create adult coloring books and I have a gambling app that I designed on the apple store :) I’ve always got a project going, be it writing or creating, that is who I am and I love it :)

My ultimate aim is to give back, paying it forward, to constantly better myself and give the audience amazing stories. Let me scare you…

Day 17 of #NaNoWriMo, not much time left now.

On day 17 of #nanowrimo2018 it feels like very little time is left. We have passed the halfway point and it seems like the rush is now on to reach the finishing line. At 83982 words today, the magic 50000 has gone and passed, but I have not finished the first draft yet as is my new goal. I'm dreading what will happen over the next days and weeks. Will I be able to finish the first draft of 'Diary of a Female GP'? Or will the work I'm supposed to start on Monday interfere too much with that?

Only time will tell and I can't make any predictions. Another four and a half chapters are waiting to be written before I reach the end. Maybe even more than that. For a first draft, do I want to also finish the back matter? I have not yet decided this, but it would be ideal if everything was finished by then. An epilogue will probably follow the main part of the book and I will need to write quite a bit more than I have so far.

But now to the progress report for today. A slow day as I needed to visit an open morning for my son today. He needs to decide on the next steps in his education soon.

Today I have only written 2033 words, and I am now at a total of 83982 words. Although this sounds like a lot, it is not in the grand scheme of things. I have not yet touched 'Growing Love' today, and I am not sure I will. A headache makes me want to take it easy and relax instead.

As usual, you will find the image of the progress below as well as an excerpt from the work in progress. This time it might be slightly boring as this is what happens in her free time. No interesting tales of meeting patients. Still, I hope you'll enjoy this little insight of what a General Practitioner will do with his or her free time, or at least part of that time.

It is still quiet upstairs and I allow everyone to enjoy a lie-in this morning. In the meantime, I get out my laptop to check any new results, tasks or prescription requests that may have come in after I shut down the laptop yesterday. With those out of the way, I check the unassigned tasks. Reports from the Out-of-Hours Service arrive here too. Amongst these is a task from Out-of-Hours regarding two-year-old Jack, the boy I saw yesterday as an extra. His mum was concerned Jack had tonsillitis, but everything was fine when I examined him. I was not convinced mum believed me when I told her, and the contact with the Out-of-Hours Service last night appears to confirm this. 
As I read through their report, I notice how mum told them about Jack’s severely sore throat, his massive tonsils and his sky-high temperature. All, of course, without the help of a thermometer. Jack and his mum were invited for a reassessment and the same diagnosis I reached earlier in the day was reached again. Since a few hours had passed since I saw him, Jack’s condition could have changed, but it appears it was unchanged when he visited Out-of-Hours.
Okay, the basic work is out of the way. Not every weekend I will do this. After all, the weekend is time off and I am not expected to work. Instead, the weekend should be time to spend with the family.
To continuously monitor and improve the quality of the care we provide to the patients, General Practitioners need to do audits. An audit is a short research we do on at least an annual basis. There can be more of those in one year. The audit I am working on relates to the care of the diabetics in the practice and looks into the diabetic control of diabetics diagnosed in a one-year period and whether any action was taken if the control was unsatisfactory. To help me do this research, I run a search for type two diabetics diagnosed in the last year and then realise this will not give me the data to work with. After all, if someone is diagnosed with diabetes in the last month, this will not tell me if the results were acted on and changes in treatment took place and what the results of any changes was. So, instead I run a search for patients diagnosed in the period between two years ago and one year ago. The search is run, and it shows me eighty-four patients were diagnosed in this period.
Now the rest of the work starts. In the ideal world, 100% of these patients should have the initial results and this is an appropriate standard to set. The next standard to decide on is which percentage would be appropriate for a re-test at three, six and twelve months following the diagnosis and I set 80% for this. In the ideal world this also would be 100%, but not all patients will follow the advice given.
From research, it is known the first year following diagnosis is important. Reaching a good control within this first year greatly reduces the risk of long-term complications of diabetes and we obviously want the best possible for our patient group. A good diabetic control would be below 48 mmol/mol, and I set 50 as the cut-off where treatment should be intensified. Intensification should happen in at least 80% of the patients with a level above 50, I decide and now I have set all the standards for the audit; I go through the notes of the eighty-four patients one at a time to search for the data required.
This is a long and boring job, but it needs to happen by hand. Only the search for the new diabetics can be done by the programme. When I find the required data, I enter them in a spreadsheet, NHS number in the first column to enable me to see which patient’s notes I have processed already. In the eventual spreadsheet, this column will be removed to ensure patient confidentiality. 

Joni

#nanowrimo2018 day 16, and the writing continues.

Today is day 16 of #nanowrimo2018. So far, I have managed to write every day and update you on the progress daily as well. I am not sure how long this will continue. It is official, from Monday I will need to give up my freedom and start participating in the working life again. The good news is, 'Diary of a Female GP' is close to being completed. The week discussed now has reached the end of Friday, only the evening is left to narrate. Once Friday is completed, Saturday and Sunday are the only days to mention and those days should not take too long.

Here is the progress report for today:

Chapters: 2
Words added: 2816
Total words in project: 81949 (yes I know, 1 more would have felt better, and 51 more better still)

The next job on the diary for today is to write 'Growing Love', not much of it, probably only a few scenes. More work needs doing, the course I started yesterday is waiting for me again too.

And here is the usual image to show the progress again, and you can find an excerpt from the work in progress too. This excerpt is slightly different. It does not show the working life, but part of the private life of the GP involved. Hope you like it.

A few notes to make the excerpt easier to follow, it's Friday teatime and Harry, Dr J's youngest son has his friend, Christian over to play. Christian's mum Anna is due to pick him up at seven and John, Dr J's husband usually returns home around seven as well.

Soon the first pancakes are ready, and I call the kids to the table. Everyone enjoys their pancakes and Christian’s second pancake is one with bacon and apple, “I’ve never had a pancake like this before, they are nice.” While the kids eat their tea, I continue to make more pancakes in an attempt to keep up with the demand. Their knives, forks and mouths work faster than I can prepare pancakes, but they will have to wait their turn. 
I’m also watching the news and this is as depressing as always. When everyone only has room left for one more pancake, I offer to make this a dessert pancake, “How about making a pancake with a face? Eyes made of ice cream and chocolate drops, a nose made of a cherry and a mouth out of a piece of banana. We can use whipping cream for the hair and eyebrows. What do you think?”
Shouts sound all around me as they are excited by the idea. When the first ones are ready for Harry and Christian, Christian is quick to pick up his knife and fork again, but then drops them next to his plate again. Instead, he takes his mobile phone out of his pocket and snaps a picture, “I want to show this to my mum. Maybe she can make pancakes like this one day too.”
Now all the batter is gone, and they finished their meal, the kids return to their bedrooms while I tidy everything away. I check the time and notice it is already a quarter past six, high time to make the preparations for our tea. John will probably be home around seven again. Today I have a treat for us, fresh mussels. Fries and peas will go well with that meal, but before I do anything, I will first need to clean and examine the mussels. All the mussels that won’t close when tapped I put to the side, I remove all the debris around them, and place them in a mussels pan we bought in France on holiday. Chopped onion and oil are waiting on the bottom of the pan and once all the mussels are all in the pan, I add curry powder, parsley and chopped garlic. All set, they only need ten minutes and I’ll wait until John is home before putting it on the stove.
Half-past six, time to put the fries in the airfryer. They take about half an hour and that’s when I expect John to be here. The peas can wait another ten minutes. And now the wait starts for John to come home and Anna to pick Christian up.

Joni

Update on Day 15 of #NaNoWriMo

The judgment is in. I'm officially mad.

Okay, maybe it isn't quite as bad as that, but I certainly get close.

Not only am I tackling the sixth book in the 'Friends, family and love' series 'Growing Love' and my #nanowrimo2018 project 'Diary of a Female GP' at the same time. I have also started a free writing course at International Writing Program, University of Iowa, today. The course is entitled 'Stories of Place: Writing & The Natural World'. The course has started today and you can still join if you wish. You can find it here: https://iowa.novoed.com/#!/courses/stories-of-place-iwp/flyer. The course is free as I said, is instructor-led from 15 November-31 December, but remains available for self-study until 15 March 2019.

Yes, I'm definitely a glutton for punishment. Other than that, my husband has requested me to come out of retirement and help him out in his business. I will shadow his manager from Monday the 19th, so I can support her and take over once she is forced to retire. Even though my husband does not want to lose her, and she does not want to retire yet, there may be little choice. For this eventuality, I need to get trained on the job. "My writing, my writing," I shake my head with my hands running through my hair. Okay, I'm sure I'll survive. Just less time to write.

So, here is the progress update for today. As expected, I have taken it easier today. Too many tasks to manage at the same time. The day started with research for my sixth book, I needed to double-check places and some details. Following that I wrote four scenes of 'Growing Love'. Not as much as I would have liked, but the #NaNoWriMo project was waiting too.

The next job was to write 'Diary of a Female GP'. Only one chapter, 1752 words today, bringing the total up to 79132 words. At least some of it was done today, right?

This afternoon I spent time on the course, not finishing the first task yet, but they advise a week for that, anyway.

And now for the image to go with the update and the excerpt from the work in progress as per usual. I hope you still enjoy this and I would love if you let me know what you think of the work so far.

Now I drive over to Trevor’s house. Trevor is only fifty-eight and terminally ill with bowel cancer. The district nurse was concerned he might not live beyond the weekend and requested a home visit for him today. 
The main reason for this is to prevent unnecessary distress for the family. In the medical world, there is something we call the two-week-rule. If a patient dies, and he has not been seen by a doctor within the last two weeks of life, the coroner needs to be consulted. This may mean that a post-mortem examination will take place, even if a patient was expected to die due to a pre-existing illness. If, however, the patient was seen by a doctor within those two weeks, the doctor can issue a death certificate as long as the doctor is satisfied as to the cause of death and that no foul play is behind this.
Trevor was last seen a little over two weeks ago by one of my colleagues. I have not seen him for quite some time and when I walk in, I’m shocked at what I find. 
Trevor always was a rather plump person, not quite obese, but certainly overweight. Today he resembles a skeleton, you can count his ribs and the jawbones are protruding. I can hardly recognise him. 
Trevor meets my eyes and smiles, “Nice to see you, doc, not seen you for a long time.”
“Yes, you are right, it must have been a few years since I last met you. How are you holding up today?”
Trevor points to the syringe-driver, “Much better since you increased the pain relief, thank you. Managing okay now.”
We chat a while longer and he tells me how it won’t be long now, “I can feel it in my bones.”
Trevor’s wife, his two daughters and a son-in-law sit around his bed. Mary, his wife, wipes away the tears from her eyes and one of his daughters wraps an arm around her, “It will be okay mum,” while handing her a hanky.
Even with the pressure of needing to leave soon, I make sure to give the impression I have all the time in the world for Trevor. This may very well be the last time I will see him alive. I agree with the district nurse, I don’t expect him to last the weekend. At twenty-five past two, I get up and say goodbye to Trevor. 
Mary and her daughters take me to the side when I leave, “How long do you think he has left? Should we ask Bill to come over from America?” Bill is their son and if he wishes to be here before his father dies, he should really be quick.
How can I word this? “I can’t really say how long it will be. Anything I say is only a guess and Trevor may surprise us. My gut tells me this is a matter of days, but as I said, he may surprise us.”
The eldest daughter meets my gaze, “Thank you, doctor, I will phone him as soon as you have left.”
There are a few more practicalities to be discussed. One is the fact that I’m not here until Tuesday and if he were to pass away before then, this would be the earliest I could sign the death certificate. Sometimes, the out-of-hours service will advise the family to collect the certificate at ten the next morning. This only adds to the distress for the family and I would like to avoid that. I wish them luck and strength in the days and weeks to follow and offer them support if they need it.
Now it is time for me to leave and make my way to school to pick Harry up. I hope I will make it in time.

Joni

How about getting Captive Love for free?

As you may realise, my first book in the 'Friends, family and love' series, 'Captive Love', is available free for Kindle, but also at other retailers. You can find the book at books2read.com/u/mYogEV

Why not get it, read it and leave a review? We #IndieAuthors rely on your reviews. Thank you!

It also gives you something to do while you wait for me to complete 'Growing Love', the 6th book in the series, and 'Diary of a Female GP', which I am writing as my #nanowrimo2018 project.

Joni

#NaNoWriMo day 14, nearly the halfway point.

Today is the fourteenth of November, nearly halfway through the #nanowrimo2018 month. Time for another update from me too.

My progress today so far:
4892 words written, which is one chapter of the book. Well over the halfway point, but editing is still needed and will take a lot of time to get right as well. So far, the first seven chapters are edited and the last few days I have edited the chapters added as I wrote them.
Total word count as per today: 77380.

'Diary of a Female GP' progresses steadily and I'm not displeased with the progress at all. My husband has informed me he needs me to do work for him from next week onwards. This will mean less time for me to write and I hope it won't stop the progress too much. We will simply have to wait and see. Chances are I won't be able to keep up with the daily updates as I have been.

The images below will show you the stats and a little excerpt of the work in progress is attached too.
I hope you enjoy these little snippets.

The fifth extra patient today is seventy-six-year-old Mabel with her painful big toe. I have managed to catch up a little and now only run four minutes behind schedule. The pressure is still on as there are still a lot of ring backs waiting, two visits and paperwork to be done before I can leave to pick up Harry. 
Mabel shows me her right big toe, which is swollen, red and hot to the touch. She is not keen for me to touch the toe either. The swelling is worst at the ball of her foot and as she has had no injury to the toe, it is most likely Mabel suffers from gout. 
“Have you heard of gout?” Mabel nods. “They also call it the rich man’s disease as in the olden days, the lords of the manor would sometimes be affected by this. If you go to castles and manors, you still often see the lord of the manor with a foot on a stool and a bandage around his big toe. That was gout. Gout is caused by uric acid crystals which collect in a joint, irritate the joint and then cause inflammation of the joint. That is most likely what happened to your toe.” Mabel takes in my words and nods her understanding so far. “To treat this, we need to give you something to help with the pain and the inflammation. We will also need to arrange for a blood test to confirm this is indeed gout. If we confirm this is gout we can consider giving you medication to decrease the levels of uric acid in the blood and therefore the risk of getting another attack.”
“Can’t you give me that already?”
Unfortunately it does not quite work that way, “If we give you that treatment already, it will lower the uric acid levels in the blood, but it will also push it to go into the joint instead and make the attack worse. No, we will need to wait until the attack has gone, at which time the uric acid moves out of the joints again and we can then confirm if this is or is not gout. If we treat the uric acid after that, this should help to reduce the number of attacks you would suffer.” 
Was I making this clear or was it only getting more confusing? Mabel nodded, and I hoped this meant she understood what I had told her.
“Now, there are a few things you can do to help. There is some evidence cherries reduce the uric acid levels. Red meat, wine, and other forms of alcohol, and cheese are known to increase the levels, so you may wish to reduce the intake of those. Sometimes attacks are provoked by slight trauma, like stubbing your toe. Any questions?”
Mabel seems to understand what I have told her, “Thomas also suffers from gout, I think the doctor told him the same thing a few years ago.”
Thomas is Mabel’s husband of over fifty years. That explains why she did not appear to be more confused by my explanation. I hand Mabel a prescription and the request for blood tests and ask her to return to discuss the results.

Joni

Day 13 of #NaNoWriMo

Another productive day today. A few more chapters have been completed and I'm close to midday on the week I'm writing about. 'Diary of a Female GP' is progressing steadily, another 6478 words of the book written (and edited) today. The grand total at the moment stands at 72488 words. Will I reach 90000? It is possible. We'll just have to wait and see.

So far, I have not written anything for my sixth book today yet. I will possibly get on with that after I return from picking up my son from school. If there is enough time left, that is. Otherwise, it will need to wait until tomorrow.

So, here is today's graph and an excerpt of the book can be found below as always. Hope you are still enjoying this.

Only one more patient remains. That is, of the list of patients who were booked into existing appointments. The rest of today’s list consists of ring backs and emergency patients. 
Sixty-three-year-old Jeffrey walks in and glances around him hesitantly. 
“Come in and have a seat,” I force a welcoming smile on my face. 
A red flush colours his cheeks, “You’re a female.”
I can’t deny that, “That is right. Did you want to see a male doctor instead?”
“Well, I’m here now, anyway.”
Jeffrey tells me about his embarrassing problem, “My foreskin is that tight if I go for a wee, everything squirts everywhere. It’s time I saw someone about it. Sometimes the foreskin even swells up like a balloon before I can finally urinate.”
After an examination confirms an excessively tight foreskin or phimosis as it is known in the medical world, we agree I will refer Jeffrey to the urology department for assessment and treatment. At Jeffrey’s age, this is not a pleasant operation. I suspect it is not at any age, but at least young children will have no memory of it. Forewarned about this, Jeffrey leaves my room, a form to book a choose and book appointment in his hand. 
While I write the referral letter, another message from Ruth to check a patient with her pops up on my screen.

Joni