NaNoWriMo, just a gimmick or does it work?

 NaNoWriMo may not work for everyone, but it does for me. Once a year, I take out time to focus on writing more than I do the rest of the year. The entire month of November, the National Novel Writing Month, I commit to writing at least a few words every day. And often this is more than a few words. 

The challenge is to write the first draft of your next novel within the 30 days of November. In October you are meant to work out your book and do any pre-planning you might want to do. And then, on the 1st of November, you start writing your book. The target is to reach at least 50000 words by the end of November, but some people may set that target higher or lower.

My first NaNoWriMo was in 2018 and that brought me 91784 words for "Diary of a Female GP". That year I was a free agent, recently retired, but returned to full-time work mid-November. The book is now published and bringing in several ⭐⭐⭐⭐⭐ reviews. You can find it here: http://books2read.com/u/m0VOVM

The second NaNoWriMo in 2019 was during a time I also had to contend with a full-time job. Time was limited and the chances of getting to 50000 words appeared not as easy. I wrote 58247 words for "Wake-Up Call".  I' m still editing this book at the moment.

And this year is my 3rd NaNoWriMo. Today is day 21 of the 30 and the first draft is not finished yet. So far, I have 60773 words and there are more to follow. The book I'm writing this year is called "Watching You From a Dark Corner". This year I was very close to not even attempting to take part and I'm so very glad I did. Time is no longer a given. Where many people involuntarily gained more free time during Covid, my free time became even more sparse than it already was. One of the drawbacks of working in healthcare during a pandemic. 

And then, just before NaNoWriMo started, eleven members of our staff went into self-isolation due to two separate cases of Covid. That last week of October I had planned to do the prepping for NaNoWriMo. It was not to be. Instead, I had to give up some of my days of annual leave to jump in as emergency receptionist. And the self-isolation continued during the first week of November, when I was due to start NaNoWriMo.

Even with the barriers thrown in my way, I forced myself to take a few hours out every night to write. And now I'm so glad I did. I surpassed the target of 50000 and a new book is waiting to be completed, edited and published.

And then earlier this week, something amazing happened. I was just about to start writing the next scene in the book and had worked it all out in my mind while preparing tea. 

The baddie was going to be called back home and would leave Lizzy alone locked in the bedroom. His ex had again entered his apartment without his permission. Something she had been doing a lot of lately, despite having been told she couldn't and having been thrown out several times too. Of course, he exploded and ordered his second in command to capture her, and hold her captive. Then he would return to the apartment to check everything was still as it should have been and she had indeed left.

And at that exact moment, the radio started playing "I don't believe you" by Pink. Of all the times to do that, it did while I was thinking out the exact scene. This song was the perfect thing to add to the story. So, now he enters his apartment to find the loudspeakers blaring out that song. Ana, has put the song on repeat to annoy him. Her favourite song, but definitely not his.

And when Demitrius steps into his apartment, it is at the exact moment Pink sings:

No, I don't believe you

When you say, "Don't come around here no more"

I won't remind you

You said we wouldn't be apart

No, I don't believe you

When you say you don't need me anymore

So don't pretend to

Not love me at all

What could be more perfect than that? Thank you Sky Radio for playing that song at that exact time. It just fitted in with the scene so well I had to use it.

Today, I will be writing a few more scenes, it's getting near to the end of the book now. And then, over the next few days, I will put some more detail in some of the scenes where I realised I left things out I had meant to add. 

By the end of November, I should have the draft of "Watching You From a Dark Corner" finished. And then there will be two books awaiting editing. Just like I had after last year's NaNoWriMo.

So, does NaNoWriMo work? Well, for me it seems to.

Joni,

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.

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

#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.

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

#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

A belated update for yesterday's #nanowrimo2018 progress

Apologies for a late update. Yesterday was a busy day, the usual household chores and grocery shopping coming first. Then I wrote another chapter of  'Growing Love', which also included a bit of research for a holiday scene. Although I had visited the area a lot in the past, I needed to double-check a few details and make sure nothing had changed. This took most of my morning and writing the #NaNoWriMo project took a bit of a step back.

Yesterday afternoon I did write another chapter of the book, 2511 words, bringing the total up to 66010 as per yesterday. The update on the progress of 'Diary of a Female GP' had to wait. No time was left over to do this last night as I needed to visit a friend in hospital.

So, here is the belated update:

Or if you prefer to see the daily progress broken down per day (bearing in mind I have not done any writing yet today as it is only eight in the morning and therefore today's count is still at 0), you can have a look below:
(I love yWriter 6 so far, a free programme with a lot of helpful things to create your writing projects)

And for the daily excerpt, here you are. I hope you enjoy it.

Ben, the forty-six-year-old man with lower backache is the first extra patient of the afternoon. Ben phoned for a sick note this morning, which he did not require and called back later in the morning as his back pain was such he wanted to be seen because of it. Or so he told the receptionist.
“Doc, I know you said I don’t need a sick note, but my gaffer..., well...,” Ben fidgets with a leaflet he picked up in reception, “The thing is..., he won’t let me take time off unless I get a note from you. Honestly, I really need that sick note.”
So, how about that backache worsening? “Can I just make sure? You are here for a sick note and not because the pain is worse? Is that correct?”
Ben nods, “Yes, it was the only way the receptionist would let me speak to you again.”
“Well, here is the situation. Legally, your employer is not allowed to ask for a doctor’s note until you have been off sick for at least one week. Employers are legally bound to accept an employee’s self-certificate for a duration of up to one week. Obviously, you should only use that option if you are unable to work. If your employer for some unknown reason insists on a doctor’s note, there is only one option for that. I can give you a private sick note, but such a note carries a charge. A charge I believe the employer should pay, but they will often leave it to the patient to pay for it instead.” 
Ben nods.
“Knowing what I have told you, do you want me to give you a private sick note? A note you legally do not require?”
“Well, if you put it like that. I will try my employer again and get back to you if he insists on a note from you.”
“And how about your back? Is it worse, the same? Can I examine your back while you are here, so we have that to back up any notes you may require later?”
“No, really, there is no need. It is improving already. No need to bother with that. Cheerio.”
Ben leaves and I wonder why people will sometimes make up things to see us.

Joni

Time for another daily update, day 11 of #nanowrimo2018

So here we are again on day 11 of #NaNoWriMo. Time for another update on my progress and this will as always include a little excerpt from my work in progress.

Today I have reached 63499 words, and I was tempted to add another one, part of my OCD really. I like to have nice round numbers. The added number of words today was 3445, so adding another one would have messed with the nice round number there anyway.

Now it will be time to get back to writing my sixth book again soon, not much has happened with that over the last few days, only about 300 words and that is nothing really.

So here is the excerpt (also on the picture above), I hope you'll like it.

Five-year-old Bradley is my next patient. Today he has come with his dad. Bradley spends half the week with his mum and the other half with his dad. Tonight he will return to his mum for a few days and then return to dad again on Sunday. Although his parents are no longer together, they sorted the childcare out well between them and work together as a team where Bradley is concerned.
The reason they are here is due to a deterioration in Bradley’s asthma. Over the course of today, his breathing has worsened, he is more wheezy and, although his inhalers help, he needs to use them on an hourly basis.
When I examine Bradley’s chest, there are a few crackles on the right and he is very wheezy. The skin on his chest gets drawn in between his ribs a little and this is again a sign he is struggling a little. I try to test his peak flow (a breathing test), aware Bradley is likely too young to be able to perform this, and it is lower than expected for his age and height. The technique shown during this test was however poor and the result is therefore not accurate. When I test his oxygen levels, they are 99% and his pulse is a little fast at 96 per minute. 
At the moment I wonder if we should have Bradley admitted. When I suggest this to dad, he is adamant Bradley has been far worse than this and usually recovers quickly with antibiotics and steroids. Bradley’s breathing appears to have settled a little and I agree to give Bradley antibiotics and steroids and let him go home, provided his parents will seek medical attention immediately if he does not improve or worsens overnight.
Before he leaves, I also book an appointment for the next morning to review Bradley again, “Although I officially have no appointments available tomorrow, I still want to see him again. Does ten to ten suit?”
“That sounds fine doctor. His mum can take him, she is off on Friday. Are you sure it’s not too much bother?”
No, Bradley needs to be reviewed tomorrow and if creating an extra appointment before tomorrow’s surgery is what is needed, I will do that. They leave, promising to re-arrange the appointment if it is not suitable after all.

Joni

60000 words behind me on day 10 of #nanowrimo2018

Another day of writing, another update. Today I have added 3473 words, the total over ten days now at 60052 words. Gradually edging towards the end of the book after another two chapters have been completed. Yes, I'm quite pleased with my progress so far. Not bad for a first-timer at #NaNoWriMo.

My next job today will be to do a little bit of editing, perhaps another chapter of this book and then continue to write some further on 'Growing Love'. For the last few chapters I was in need of some research. The information is still somewhere lurking in that head of mine, but I can do with a slight reminder. Suffice it to say that details about a holiday location need to be double-checked with the knowledge hidden in my brain.

There won't be a lot of time left to do this today, I have promised to cook Chinese for the family today. That always takes about an hour and a half to prepare.

But, for now, here is the update on the progress and another excerpt of the work in progress can be found underneath. Yes, 'Diary of a Female GP' is progressing nicely.

I love Baby Clinic, or well baby clinic as it is officially called. During Baby Clinic we see babies for their eight-week check or their heart checks at the age of one. The little cuddles and playing with the little ones always make me feel happier and also make me feel broody. Yes, I know, I already have four children.
The first one on the screen is eight-week-old Joshua, who has come with his parents. His beaming mum and dad walk in the room with Joshua in his carseat.
"Congratulations. How is everything going? Do you enjoy being parents?"
Their smiles become even wider and their eyes shine as Joshua's parents confirm they love being parents.
So far, no problems have been found. Joshua feeds well, he is breast-fed, and he smiles and follows movements.
Now it is time for Joshua's check. Mum carries him to the couch, closely followed by dad, and undresses Joshua, leaving his nappy on at my request. In the meantime I wash my hands and grab a stethoscope and ophthalmoscope (a tool to look into eyes with). For the checks, I start at the top and work my way down the body. His soft spot feels normal, his eyes are open and he follows where mum goes. When I look in Joshua's eyes, the light reflex is normal. Joshua's mouth seems normal, his neck and shoulders too. He has two arms with hands and the expected number of fingers. The heart sounds normal and the lungs too. Joshua's tummy shows no abnormalities and there is no evidence of a hernia. Both hips are stable. When I check his private area, all is in order there as well and his testicles have descended ( a real feat considering my hands are usually freezing cold). Joshua's legs, feet and toes are fine and all reflexes are normal. Now I turn Joshua over and a check of his back is also unremarkable. He does have a 'storkbite' though, a little birthmark at the nape of his neck. 
The last thing I check is mostly for the benefit of the parents. When babies are this young, they often still have an old 'walking-reflex'. I lift Joshua up and let the top of one of his feet touch the couch. Yes, as expected Joshua lifts the foot and places it on the couch, the next foot follows and he takes a few steps. His parents absolutely beam at their brilliant son.
Now that Joshua has passed his first check with us with flying colours, mum dresses him again while I enter all the details of the examination on the records.

Joni

It's #NaNoWriMo day 9!

I have put 'Diary of a Female GP' to the side for today. Even though I have not written a lot of words today, I'm still on track to complete the first draft of this book by the end of the month, I believe. 

Twenty-five of an estimated forty-three chapters have been written so far and today's total is 56579. A total of 4009 words have been added to the project today.

After my update yesterday, I finally gave in to the urge to edit some of this book. By now, the first five chapters have been edited for an initial time. Once the first draft is complete, I will read through and edit the book again. Only after that, I would estimate the book ready for the beta-readers. So, if there is anyone out there who would like to help me out and read the book before anyone else does and give me their opinion, please let me know.

The next job on my list is to have some relaxation time now and update myself on e-mails and social media and the like. After that I'll get back to writing 'Growing Love'. That has been rather static over the last few days. The need to complete that book is growing steadily. In the near future, my husband may need me to help him out at his business. If that will happen, the time left for writing will be greatly reduced. The sooner I get the book finished, the better it is.

Now for the daily excerpt, here you go, I hope you enjoy it. But as always, please remember this is still a work in progress.

When I return to my room afterwards, a ringback marked 'urgent' is waiting for me. Before doing anything else, I open the notes to check the details. "Paramedic with patient. Requesting urgent visit. Please ring asap," it reads.

The daughter of eighty-seven year old George has phoned an ambulance as he was struggling to breathe and she suspected he needed to be admitted. George suffers from severe COPD (chronic bronchitis) and is bringing up thick green phlegm. Even simple activities like putting his clothes on, have George gasping for air. After the paramedic has given me this background information, he then continues to tell me about his oxygen levels, which are only eighty-two at the moment.

Why are they even asking for a visit? George needs to be in the hospital, not to wait for me to do a visit and lunchtime and then be admitted to hospital.

"George does not want to be admitted, doctor, and we can't transport him against his wishes. We would therefore ask you to come out now to see George as an emergency."

Sorry? Come again. They want me to leave a busy surgery with patients waiting to be seen? Only so they are covered if they leave as George does not want to be admitted? "Sorry, I'm afraid I'm a little overstretched at the moment and will not be able to see George until later today. But really, he needs to be in hospital with the symptoms and signs you just mentioned."

The paramedic asks if I can speak to George in that case.

"How are you feeling George?"

"Like a wrung out towel to be honest. But I don't want to go to hospital and be told I'm a time waster." George needs to take a breath every other word, he is really struggling.

"George, it does not sound like you are a timewaster. You sound like you need to be in hospital and I would strongly advise you to go with the ambulance who has come for you."

George sounds dejected, "Okay, if you really think it is needed I'll go." He still needs to stop every other word to catch his breath.

Pleased to have succeeded to convince George to do what is best for him, I continue to the next thing on the list.

Joni

#NaNoWriMo Day 8.

And here we are again. Another update on the process and another day spent writing a little. 7467 words more to be exact. And this means:

I've crossed the 50000 words threshold today. Yippee, no more stress, no more pressure. Only the pressure I put on myself, which obviously continues. 'Diary of a Female GP' is well underway and half-way to completion of the first draft, I estimate.

So, now my target has changed. 50000 is no longer the target I work towards, after all I have already gone over at 52553 today, but I aim to complete this novel this month. So, all the words this novel will have eventually I want to be written. I also want to have a first edit of the book done, so I can look at re-edit and second draft by the end of this month or December at the latest.

And then? Then I will need to find some beta-readers for advice and then re-edit, final draft and publish. Perhaps this can be done by the end of January.

Of course, 'Growing Love' is still waiting to be completed as well. I'm working the last few chapters of the book and hope to be done with the first draft by the middle of November.

Now, for those of you who are waiting for another peek, here is another little excerpt from 'Diary of a Female GP', the work in progress for #nanowrimo2018.

Claire agreed and left and after signing a few new electronic prescriptions and grabbing the box of prescriptions I already signed, I got up to leave my room.
At that moment there was another knock on the door and Carly walked in, "Can I have a word?"
What now?
"I'm so sorry, Dr J, but I have just had a call from Dr K. Dr K won't be in this morning due to illness. We have a problem. All Dr K's appointments for this morning are already fully booked, what should we do?"
That indeed is a problem, the nightmare already starts before the first patient even enters my room. 
"It can't be helped, we'll have to do what we can and cope. If you girls try and rearrange the appointments you can, I'll see the ones who can't be rearranged or turn up before you have had a chance to reschedule them. We'll just have to fit them in where we can. We've done it before and have managed. We'll do it again. I'm sure we can cope if we just work together like the great team we are."
Yes, I hope we will. Personally, I am not so sure, but I have to keep the morale up. A lot of the practice lays on the receptionists' shoulders. Without them doctors would be nothing and could do nothing. In reality it is not so much the doctors who keep the practice running as it is the receptionists. Well, we really need the entire team. Together we can be strong and deal with the pressure put on us, unless that pressure becomes too much. Will it be too much today? Time will tell.
"But I'm so sorry for you, Dr J, it seems like you always end up with these situations."
I'm sure that's not entirely true, it must happen to my colleagues on occasion as well. Although I don't call in sick very often. In general, I will even get to the surgery if I have to hold myself up on the walls to make sure I don't fall down. I hate letting anyone down and will drag myself in to work even if I don't feel well. On occasion I have had patients tell me, "You don't looke well, doctor. You should see a doctor." Which, of course, I do every day. Either at work or at home.
I hand Carly the prescriptions and make my way upstairs to get ready for the nightmare that will be today.

Joni

Day 7 of #nanowrimo2018

Time for another update.

Today I have taken it easy, it's my birthday after all. Still, I have written 4183 words on the project, bringing the total so far up to 45086 words. Not bad over seven days I think. I have so far not written anything on my sixth book yet, but I have also published another book review on a book I've read.
Other than that, I have also baked a cake, it's my birthday after all.

I hope everyone else taking part is doing well too.

And here is another little excerpt from the work in progress,

Now I continue with the electronic prescriptions, signing them and signing a few of the prescriptions in the box I brought down with me as well. Once the electronic prescriptions have been dealt with, I move to deal with the tasks, but notice there is another patient awaiting to be dealt with on my screen. In the bottom of the screen on the clinical system, several coloured squares show, which contain numbers. Some are for the results, showing how many results there are in total, how many there are for me and how many there are with no clinician assigned. 

Next to that it shows the letters in much the same way, total number of letters with next to it number assigned to me. 

The next line of coloured squares shows all my appointments for the current session, the number of patients seen, the number of patients awaited, the number of patients who have arrived and the number of patients waiting for me. 

The following squares show the total number of electronic prescriptions, and the number assigned to me.

The last group of squares relates to the number of tasks, total number, tasks assigned to the group I belong to and tasks assigned to me.

In the square of patients awaited, there now shows a number one. Another patient has been added to my list. As I don't want any patients to slip through the net through either my own or someone else's mistake, I return to the appointment screen and find another ringback waiting on my screen. Why did no one alert me? Or is this again a ringback added in error?

When I open the patient's notes and check details of the ringback, it only states "Personal problem. Patient wants to speak to you."

Oh, yes, it is Eleanor, a forty-nine year old lady who only wants to see and speak to me. For some unknown reason, she only trusts me. We have patients like that and I suspect there are patients like that in every GP practice. Usually she wants to talk about her panic attacks and I take a deep breath and phone Eleanor.

"Oh, thank you for phoning back doctor. I would like to make an appointment to see you please."

Huh? Why did she not ask the receptionist for an appointment?

"Is there any reason why you wanted to speak to me today other than to book an appointment?"

"No there isn't. Do you have any appointments next week perhaps?"

"Eleanor, there is no need for you to speak to me to book an appointment. Perhaps you can phone our receptionists to book an appointment?"

She agrees and we finish the call. My mind boggles at why she would want to speak to me to book an appointment. Five wasted minutes in which more of the paperwork could have been completed.

Joni

#NaNoWriMo Day 6, still going well.

I'm still going full steam ahead for #NaNoWriMo2018.
Today I spent most of the morning writing on my project and I'm now gearing up to continue writing my sixth book 'Growing Love' again. There is still a bit left of the book and I would like to finish the first draft of this book soon as well. Although I'm getting close to the end of the book, I'm still not quite there yet.

So, how did I get on with 'Diary of a Female GP' today? I have now passed the 40000 word mark and have reached 40969 words, today 6772 words were added to the project.

I hope you are enjoying my daily updates so far, with the little excerpts from the book as well.

Here is another taster:

And then it is time for my fifth patient already. The amount of time I was ahead, has now been reduced and shattered and instead I'm running five minutes behind. Oh, well, you can't have it all I guess.
Thirty-seven year old Jenny comes complaining of abdominal discomfort and bloating. She has gradually increased in weight over the last few months and denies any possibility of pregnancy, "I'm just getting fat, should stop eating rubbish."
When I ask her when her last period was Jenny informs me she has no idea, she has always been irregular and doesn't keep track. "They come when they come and that's just how it is."
After asking her to lay on the couch so I can examine her, I have a good feel of her stomach. It is quite large and, if I am to believe Jenny this is due to obesity. However, I'm fairly certain I can feel a baby inside. Even if it is not moving at the moment, I'm fairly sure I can feel the head, the body and the limbs. No chance of pregnancy? I'm definitely not convinced. 
"Jenny, I believe you may be pregnant after all. Would you like me to check if I can find a heartbeat?"
Jenny's eyes shoot wide-open as does her mouth. Speech appears impossible, but she nods.
I walk to the cupboard and collect the doppler. Hopefully the battery is still working. After putting a bit of jelly on the probe, I place it where I expect the baby's heart to be, and..., indeed, there it is. A fast heartbeat can be heard.
"That is my heartbeat, though, isn't it doctor?"
Not a lot of patients have a resting pulse of around one hundred and twenty a minute. I move the probe to where it picks up her heartbeat, "This is your heartbeat. Nice and slow." I move the probe to the baby's heartbeat again, "And this is the other heartbeat. Hear, it's faster."
"But..., but...," Jenny can't get her words out easily, "I can't be pregnant. This can't be true."
Well, I'm afraid it's too late now. When I examined Jenny it felt like the womb reached to around thirty-six weeks already, there is no going back now.
After informing her of the approximate pregnancy duration and advising her she will probably need to prepare herself real soon, I arrange for an emergency referral to the midwife. If my estimation is correct, she only has about four weeks left. Not a lot of time to get used to the idea of becoming a mother and preparing for it. Not quite the surprise you would expect on your visit to your GP.

Joni

#NaNoWriMo Day five.

 
Okay, so today is not something to write home about. Too many other things have interfered with the thing I needed to do, write.
Instead, I have spent time doing the housework (also necessary), the shopping (the family needs to eat after all), booking a short trip in December (not urgent, but would help) and sorting a few other things out.
But, I have still managed to write to, albeit short, chapters of the project.

Current word count: 34197
Today added: 1898 (yes I know, I should do better)

This is, however, a convenient place to stop. The end of a chapter, while I already know the next chapter is going to be a long one.

Ready for another short excerpt? Here we go (it's not much, but something is better than nothing, right?)

Again, I walk back to my room after and start preparations for the day. A few more of the letters waiting are dealt with, and I notice the complaint I received yesterday. I will need to make some time to answer that one as well today. Officially we may have two weeks to answer a complaint, but I always feel the sooner it is dealt with, the better. I absolutely hate receiving complaints. As a perfectionist, I always aim to do the best I can for all my patients. A complaint to me means that I have failed in doing that and that hurts, a lot. It makes me wonder if I will ever be good enough, or whether I never was good enough in the first place. Still, I must be to have gotten this far.
After putting the complaint to the back of my mind for the moment, I return my attention to all other jobs still waiting for me. The letters. Electronic prescriptions that have been put in my inbox since this morning, tasks that have been sent already. At least I'm not on call today and that is something to be thankful for. 

Joni.

Day four of #NaNoWriMo

And another update from me.

The project progresses nicely. I have now completed Tuesday and tomorrow should get started on Wednesday of the week in the diary.

Today I have added another 5155 words to the project, bringing the total at the moment up to 32299 words, and sixteen chapters completed.

I have also spent time on the draft of my sixth book in the 'Friends, family and love' series, 'Growing Love'. For this book I have nearly added another chapter and with this another 2329 words, bringing the word count for this book up to 125169.

And, just in case you would like to read another excerpt from the unedited draft of the #nanowrimo2018 project 'Diary of a Female GP', here it is:

My next emergency patient is the lady with hairloss I nearly forgot about. Fortunately she was able to accept the afternoon appointment and I hope she is not too angry with me for not being more accommodating towards her.
When Melanie enters, she appears extremely annoyed. I'm running a little late and she is seen six minutes after her appointment time.
"This surgery is rubbish. There are never any appointments available if I need one." Although I am tempted to point out several appointments were available last week when she claimed there weren't, I hold my tongue. "When I phoned this morning they told me you would ring back within an hour." I am quite certain the receptionists would never make a promise like that unless there was an emergency and in that case they would have warned me about this. "Instead, I was kept waiting for hours and when I then finally get an appointment for this afternoon, you keep me waiting another half an hour." Again I am tempted to point out I'm only six minutes late, but I bite my tongue again. She takes a deep breath before continuing, "This practice never does anything to help patients. I could have been dead already." Dead of hairloss? Really? That is not something I have ever heard about. "Really, I should put a complaint in and I think I will. You have seriously neglected my needs." She pauses for a moment, "Actually, perhaps I should go with the paper with this. That will teach you to treat people properly. You are a disgrace."
I take a deep breath, hoping to control myself before addressing the Melanie, "I am really sorry to keep you waiting and you have been able to get a suitable appointment. To be honest, I was not aware I was running behind half an hour already, but I do apologise for the inconvenience I've caused you. But now that we are here, perhaps you can tell me what seems to be the problem." Oops, I nearly pointed out that I was only six minutes late and that really might have blown up the situation.
"Well, it is like this doctor. Over the last two months I've been losing loads of hair. I'm convinced I'm going bald and you need to do something about that."
"When you say you're losing hair, how much is this? Are there clumps on your pillow, any bald patches you have noticed?" While I glance at Melanie, she appears to have a full head of hair, but I have not yet properly examined her.
"No, not clumps on my pillow, but there is a handful of hair in my hairbrush when I brush it after washing my hair. Surely that is not normal. I'm convinced my hair feels thinner as well."
After examining her hair, there is no sign of any bald patches or even thinning of her hair. I offer Melanie to perform a few blood tests to rule out some of the causes of hairloss and inform her that so far it does not appear likely she is going bald. My reassurances fall on deaf ears as Melanie still appears thunderous and when she leaves after advising her to return if things don't improve or if they get worse, I wonder if I will have another complaint on my desk in the next few days. 

Joni