Wednesday, 10 February 2021

The Only Way is Up: getting the Covid-19 Vaccination

Two days ago, on Monday, 8th February, I received my first Covid-19 vaccination. I feel moved to post an account of how I came to get it, how it was and how it felt afterwards because I was blown away by the positive response of others on social media when I posted news of my good fortune. 

I was at first a little hesitant to do the “I've had my jab” thing on social media, fearful that it might look rather smug and “look at me”. I sought the opinion of a wise and trusted friend who often shares my views on such matters, and she assured me that to post about it would be welcomed by many. She was right. I am a very small voice, but if enough small voices say the same thing, they become a loud and influential voice. I am pleased and proud to learn that vaccine take-up is so high in the UK, but worried that it has been low in certain groups. I hope that anyone reading this will be reassured that it's the right thing to do, for themselves and for everyone. We all owe it to each other to talk up the good news of this rollout, not least given how much else has apparently gone wrong here in the UK.

I was aware that the UK’s vaccination programme was going remarkably well, and that as a man of my age living with Type One Diabetes, I could reasonably expect to be called sooner rather than later. However, I was thinking maybe sometime in March. I was more anxious for others in my household, three of whom work in schools and two of whom are required to be there in person; I am in the fortunate position of being able largely to control my own exposure to others, although I have throughout the pandemic resisted the urge to hide away and attempt to eliminate all risk.

Then last Friday, my younger daughter, who has mild learning difficulties, received a call from our GP inviting her to come for a vaccination on the following Monday, at the end of the working day. We had not been aware that she was in Priority Group 4, but they explained that all with a registered learning difficulty are classified as such for vaccination purposes.

Great news, we thought, not least as her work as a welfare assistant in a primary school exposes her daily to risk.

Then on the day of her appointment, we got another call from the GP practice: they had more doses than anticipated, enough that if I and my wife were able to come along too, we could all three have our vaccinations. We are both in our early sixties, and of course I have an added background risk through diabetes.

The whole process, from notification to injection, exemplified all that is good about how the UK’s programme is working. It felt personal and local, and strengthened my sense that the vaccine rollout will prove to be UK Primary Care’s finest hour. Ours is a relatively large practice in a small town - Ash Tree House in Kirkham, Lancashire; we have been patients there since moving to the area in 1986. Over the years, the practice has been there through all our medical needs of those 35 years, and many of the staff, clinical and non-clinical, have been known to us through personal or other professional and personal connections. We have had many occasions on which to feel grateful for their work.

In the case of this vaccination, communication was by phone, and was cheery, concise and personal. Our appointment was at the clinic in Kirkham, a place familiar to us from when the children were little. Not an ideal venue for a mass vaccination programme, but the most suitable NHS building in the town.

On arrival, we were greeted by a man and a woman marshalling the Car Park in hi-vis jackets, wrapped up against the bitter cold and wearing masks; only when we got near did we and they realise that we were old and good friends, former neighbours with whom we remain in touch and with whom we still socialise - well we used to! Another great thing - volunteers doing their bit: they are both retired police officers.

They, and everyone whom we saw throughout the process, were friendly, upbeat and welcoming. A young woman from our practice (a member of the admin staff) was at the door, letting people in one by one from the queue shivering outside the building. She herself was clearly freezing, and had to repeat the same words to everyone, but did so with a cheery smile, an apology for the wait, and an apologetic tone that suggested she was well aware that her questions checking our status were almost certainly superfluous.

The Practice Manager who checked us in and showed us to the waiting area recognised me and greeted me by name - such is life in a small town community. Her manner, at the end of a long and busy day, when she and everyone had clearly been on their feet all day, was positive, welcoming and reassuring. There was, throughout the building, a palpable sense of togetherness and teamwork in a less than ideal setting.

After a short wait in a room carefully adapted with temporary screens for distancing purposes, we were called through to be vaccinated. My wife and daughter received their jabs from one of the GPs, I from a practice nurse. It was quick and painless.

Side effects? Yes, entirely as predicted, and no reason whatsoever for alarm or hesitancy. We all had some degree of flu-like symptoms: shivery, achy, and lethargic. But very much just the next day, and by now (the second day) I am fine, as are they.

And which vaccine? Ours was the Oxford AstraZeneca - very much the dominant and default vaccine in the UK at present, for well-documented reasons. I have to say I wanted it to be that one, for the very silly reason that I am genuinely proud to be a graduate of a university whose scientists have done so much to develop and bring this vaccine to us at such astounding speed. Not long ago, the pernicious spirit of Trump and Brexit was claiming that we had all “had enough of experts”. I always thought this was dangerous nonsense, and if there’s one thing the Coronavirus pandemic has taught us, it’s that we sure need our experts. And Oxford University, so often criticised as élite and out of touch, has done us all a favour by reminding us that we need expertise and excellence, we need élite places of learning, we need places that select the best, and it’s not entirely their fault if those who prove to be the best do not come from the broadest of social backgrounds – that is an issue for society to address, and I wrote about it here

So there you are: a positive story in a year of gloom. It is my fervent hope that I shall soon see loads of posts on social media of people I know having had their jab. I shall get the same pleasure seeing that as others appeared to get from mine, and it will reinforce the sense that we are, despite all the caveats and warnings, heading to a better place as the days start to get longer and warmer. And just as we so joyfully did at that Olympic Opening Ceremony back in 2012, let us celebrate and be proud of our NHS, and all who work in it. 

Thank you, NHS, Thank you, scientists. Thank you, experts.

I need an optimistic and upbeat song as a title – how about The Only Way is Up?

Saturday, 30 January 2021

Lead Kindly Light: A Candlemas connection to an ancestor to be proud of.

“Lead Kindly Light” is not exactly on the A-List of well-known hymns, even to regular churchgoers, but it has long been well-loved by fans of choral music. The tune to which it is most commonly sung these days, Sandon, was composed by my 3x Great Grandfather Charles Henry Purday, a nineteenth century composer and musician who sang at the coronation of Queen Victoria. Purday is better remembered as a music publisher, and as a pioneer in the movement for copyright law reform, but Sandon remains as his best-known musical legacy. 

Purday's appealing melody, and the plaintive yet comforting words written by John Henry Newman at a time when he was feeling troubled and alone, make it a particularly appropriate piece for our difficult times:

However, it also works well as a title for some thoughts on Candlemas, one of many neglected or forgotten Christian festivals which could do so much to help brighten our year, especially in times like the present, which are both literally and metaphorically dark. Before moving on to that, have a listen to my Great-Great-Great Grandfather’s composition, sung here by Ely Cathedral Choir:

So, what of Candlemas? Among the many reasons why I follow and commemorate the life of Jesus of Nazareth is that doing so can give a form and pattern to our necessarily secular lives and provide opportunities for constructive reflection. Candlemas Day could be seen as a landmark in the Christian year, a moment of ending and new beginning. It falls towards the end of winter as we start to see the first signs of spring. Candlemas is a rather forgotten and neglected festival, marking the last day of the Christmas Season, and traditionally the day on which a Christmas Crib is put away, having been left in place when all the other decorations came down on 12th night. In our house, the two cribs stay defiantly in place until February 2nd.

Candlemas commemorates the Presentation of Jesus in the Temple, six weeks after his birth, as told in the Gospel of St Luke. Presentation of a child was - still is - a standard rite of passage for a Jewish child, but the story is told of an old man in the Temple, Simeon, who on seeing the infant Jesus brought for Presentation, declared that he had "seen the Light of the World",  and could now die happy. 
Simeon's words give us the Nunc Dimitis, a familiar part of the traditional Evensong. I personally find these among my favourite words from scripture, replete with meaning and comfort:-

It's easy to see how this recognition of Jesus as the "Light of the World" developed into Candlemas: a festival of light in the depths of winter is an appealing idea that long pre-dates Christianity, so the Church took it over in the same way that Christmas and Easter were "Christianised" versions of earlier festivals. What's surprising is that neither the Church nor the exploitative commercial world has ever made much of Candlemas in the way that happens with Christmas, Easter and various Saints days.

I think that's a shame. If ever there was a time of year when we need a nice little extra festival, it's surely the end of January/start of February. It's famously a depressing time of the year, with "Blue Monday" in mid-January often designated by expert psychologists as the most depressing day of the year. A case of being paid a lot of money for stating the obvious if ever there was one. So surely, we should all jump at the chance to have a little celebration at this gloomy time of the year. A bit of light in the darkness, just as Jesus was, and is, a shining light of goodness in an often dark and evil world.

In recent years, the church has adopted Christingle as a festival of light, but rather unwisely Christingle gets crammed into Advent and so gets rather caught up in the pre-Christmas busy-ness. Caught between the church's unwillingness to sing carols and celebrate during the restrained and dignified season of Advent, and a desire to anticipate the coming of the Light of the World, Christingle seems to me to be rather an incongruous intrusion in Advent, which deserves better.

So how about we start celebrating Candlemas a bit more, with or without the Christian overtones? A nice, low-key affirmation of light in the darkness of February, with perhaps a wholesome winter casserole at a candlelit table. How about a drink to celebrate the end of dry January? And as for music, well the playlist, both sacred and secular, is wonderful: Love Shine a light, Shine, Candle in the Wind, If I can Dream, Blinded by the Light, Ray of Light, any Nunc Dimitis, Lead Kindly Light, Christ is the World's true Light - even Shine Jesus Shine if you really must. There's a playlist at the bottom of this post.

It's not an original idea to mark Candlemas. It's a day steeped in folklore, derived from the idea that the end of winter may, or may not, be in sight. The Americans call it Groundhog Day - when this animal emerges from its burrow after hibernation and goes back in if it sees its own shadow - this recognises the not unreasonable idea that if the weather is sunny and settled at the start of February, there is every chance that winter will re-appear before spring finally gets going.

The same idea is present in an old English rhyme:

So keep an eye on the weather on February 2nd, and celebrate Candlemas that day, or maybe the weekend before or after. Whether as a Christian wishing to acclaim Jesus as a shining light in an often evil world, like a candle in a darkened room, or just as a welcome relief from the doom and gloom of January and a chance to keep those Easter eggs at bay, it's worth a go. Close the curtains, dim the lights, pour yourself a nice glass of red, light a candle or two, and enjoy the winter whilst looking forward to summer. 

Here's a link to my Candlemas Spotify Playlist:

Wednesday, 6 January 2021

Wake me up before you go-go (too low): FreeStyle Libre 2 comes to the NHS.

The long-awaited FreeStyle Libre 2 has arrived in the UK, and is now available on NHS prescription as a straightforward replacement for Libre 1.

It has to be said that compared to all that is going on in the world of healthcare at the dawn of 2021, this is of relatively minor importance, but it is nevertheless good for those of us living with diabetes to have a small piece of good news to greet the new year, and a welcome reminder that the NHS continues to move forward and evolve policy even in the midst of the Covid-19 Pandemic, its biggest ever challenge.

I hope that this post can answer a few questions, give everyone living with Type One Diabetes something realistic to look forward to in terms of improving their well-being, and as I have always done since becoming involved in a small way with the diabetes community, can do something to widen access to the benefits of a small but life-changing device.

A couple of formalities before I move on:

Firstly, a disclaimer: I am able to review Libre 2 at this early stage having been provided with two sensors and a reader by the manufacturers Abbott. I am one of a number of UK users to whom this opportunity has been offered, with no strings attached other than a requirement to disclose that fact. I have been part of this group since early 2015, having been one of the first in the UK to use Libre after its launch in late 2014. I was able to afford to self-fund it at the time, and as soon as I started using it, found it to be the single innovation which could most improve my life with diabetes. I wrote good things about it on social media and in a blog, and was subsequently contacted by Abbott to ask if I could feature in some promotional material, and was invited to gatherings of people with diabetes to share knowledge and opinions across different countries. We have never been asked to endorse or advertise Abbott's products. I have always been acutely aware of my good fortune, and have tried to use it to help spread the benefits of Libre as widely as possible, and that remains the case with this latest new version.

Secondly, a caution: the roll-out of Libre 2 is under way, but at a time when the NHS is under extreme pressure, and it is perfectly reasonable if HCPs are unable to prioritise requests to switch to it, or to deal with queries and concerns. If you read on, you will see that I am very positive about it, but I am at present unsure whether I will be able to get Libre 2 sensors on prescription straight away. I shall ask, but with a clear expectation that I may have to be a patient patient. Please show patience and understanding if you can't get it; it's great, but you can live without it for a few more weeks while greater needs are attended to.

So what is there to say about FreeStyle Libre 2?

Well relatively little to be honest - and that's a good thing! It's the Libre that millions around the world have grown to know and love, but with what many saw as its main weakness now addressed: it can warn you when you're going low or high. In that sense, it is much closer to a “true” CGM than Libre 1 and therefore a big step forward. And it's still free to those who meet the criteria.

The sensors look the same, come in the same familiar yellow box with a different name on, and are applied with the same applicator. Out of the box, it is impossible to distinguish a Libre 2 sensor from a Libre 1 one. Crucially, they cost the same, so no CCG or doctor should have any reason to delay or refuse a switch on cost grounds.

You don't even need a new reader if you've been using the LibreLink phone app, but if you want to use a reader, you do need to change it, and Abbott will swap it free of charge. I did ask for a reader, and will explain why later in this post...

You don't have to set the alarms, but if you don't set at least one of low or high, there seems little point in getting it at all! I set mine for low (it defaults to the widely accepted 3.9) but not high, and it worked faultlessly. On my first day using it, I started the sensor after breakfast and deliberately took my usual dose of insulin but with a bit less to eat (be careful if you do that; I was home all morning with others in the house!) Sure enough, my level fell and even though I knew it was falling both by how I felt and by a few swipes, I waited with excitement for the alarm. (I am easily amused). When it came, it was strident and persistent:

It would be hard to ignore or to sleep through it. A quick swipe in response to that prompt, and you immediately see what the problem is:-

So with some small satisfaction, on my first night wearing it, I turned off the 1:30 am alarm which had been on my phone for almost 20 years, safe in the knowledge that I would be awoken if my BG was falling, a problem from which I have on occasions suffered, and which twice in my early days with diabetes led to alarming (for my wife!!!) seizures. I am pleased to say it didn't go off, and I had a good night's sleep. 

PS - on the second night the alarm did go off, at 1:05, waking me and startling Mrs L. I had sort-of hoped it would, and accidentally-on purpose didn't have a bed-time snack as I normally do, despite a relatively low reading at that time. So another slightly risky induced low and it really has proved its worth.

So yes, in that sense, a big improvement in my diabetes management: one less hassle (that 1:30 am alarm was a minor irritant) and one less worry. FreeStyle Libre 2 will indeed Wake me up, before I go-go too low. There you go - a song title for this post, as always. Who needs an excuse to watch George Michael and Wham! at their 1984 best?

Any disadvantages?

Well basically that you still have to swipe and read to find out what the level actually is, although self-evidently if it triggers at 3.9 or whatever, that's what your level must be if you swipe immediately. The trend arrow (still in my view the most important feature of Libre) tells you whether it's falling sharply or gently, but if a low alarm sounds it would be unwise to ignore and do nothing. If you want warning before it gets that low, set it at a higher trigger level; I am always fine at 3.9 and nowhere near needing assistance at that level, but YDMV so others might wish to be warned before it gets that low.

Personally I would find high alarms annoying. Highs are not immediately threatening in the way that lows are, and I don't need a device to tell me when I'm thirsty, blurry-eyed and generally feeling like I've got a hangover without the pleasurable memory of a good night out. I may yet set up a high alarm, maybe at a level higher than I normally venture, for me maybe towards 20.

You can only have alarms on one device, the one you scan first at start-up. I use the phone app most of the time, but as I said earlier, I opted, with this first sensor, to use a reader as the alarms device. So why did I ask for a new reader?

Two things:

Firstly, I find it easier and more instant than the phone app. On my phone, getting a reading is sometimes a bit hit and miss as you try to hit the sweet spot of NFC, whereas the reader is always very quick to pick up a reading once it's near the sensor. I think the Libre 2 one is even better at this than its predecessor, but mine was getting on a bit (6 years old). In the night, I want quick and instant access, and keeping a reader by my bed makes it easy to check having barely woken up. Moreover, I resist using a phone at night. If you're not careful, whilst checking BG you see a message or breaking news notification that tempts you to open it, and before you know it, you're wide awake and fretting about something or someone. I choose to shut down my link to the outside world at bedtime and I prefer to keep it that way if possible.

Secondly, driving. I covered this aspect in a blog post once before (it's here) and it launched some debate and dissent. However, when I do resume driving further than the two miles to my local supermarket or pharmacy, I believe that Libre 2 will add another level of safety. I shall keep the reader on my dashboard where it will warn me if I have failed to recognise a falling BG level. (I might even set it at the proverbial “5 to drive”) and the same reasons why I avoid the phone at night apply even more when driving. Indeed, as I said in that previous post, to hold a phone for any reason whilst driving is illegal, whereas to hold a Libre reader isn't (it’s not an internet-connected communication device). If the alarm has gone off, a driver could check it with minimal disruption to concentration whilst driving, for example on a quiet, straight road, by pulling in if safe to do so, or dare I say on a straight and quiet motorway. No more dangerous than eating a sweet, sipping water, glancing at the SatNav, changing radio station or changing the heating temperature I believe.

Oh, and one more reason? It's a tasteful shade of blue, as opposed to the black of Libre 1:

So there you have it. Libre 2 is undoubtedly a no-brainer improvement on Libre 1, and I would assume any current user would wish to change as soon as possible. Those who fret about alleged inaccuracy and constantly compare Libre readings to finger prick tests will probably still find reason to criticise it, because it's still flash not CGM, so the same cautions about time lag between interstitial fluid and blood glucose apply. But remember BG levels move fast at times for anyone with T1D, so there will always be discrepancies - try pricking two different fingers a few seconds apart and you might get a shock at how even that can vary.

I remain a tech-sceptic diabetic: I have never really seen reason to seek pump therapy, let alone a looping add-on, as I find that the multiple daily injections that I administer (often well in excess of the basic 5) are of minimal interference with my life - barely more hassle than going to the loo. All the tech stuff seems more trouble than it's worth and often appears for some to become more of an absorption than the condition it purports to render easier to manage. I am famously not really very interested in diabetes, so ironically this makes me prefer MDI for now.

FreeStyle Libre does, however, liberate us from the biggest burden and frustrating paradox of diabetes, that inescapable reality of which I often speak: that the drug which keeps us alive is also, in day-to-day terms, a constant threat to our wellbeing. All we need to mitigate that threat is a still small voice to remind us when we are in danger.

I hope that most of those who are lucky enough to have FreeStyle Libre on prescription will experience a smooth switch to Libre 2 sooner rather than later, and in broader terms, I hope that non-invasive monitoring will rapidly supersede what already seems to me to be the archaic and messy practice of drawing blood from our fingers. Basic guidance from Abbott is here:

In conclusion, there are, as always, thanks and acknowledgements to be delivered:

Firstly, to the team at Abbott, who have brought to the market a device which is both valued by patients and affordable to publicly funded healthcare systems across the world. The company has been criticised when any issues occur, notably with sensor supplies, and the fact of their having a monopoly on a prescription device has been questioned, but in my experience, they have continued to listen to feedback, and to innovate and evolve the product in response to feedback. Libre 3, a refinement of 2, has been approved and is already on its way in due course.

Secondly, to HCPs who have recognised the potential value of having non-invasive monitoring available at an affordable cost to a mass market; they were led by Professor Partha Kar, OBE, who despite his constant claims to be “just doing his job” took on the task of getting Libre approved by the NHS and rattled enough cages to make it happen, driven by the interests of those whom he serves, not those for whom he works.

And finally to those patient voices who have in various ways made clear that Libre was a genuine leap forward in diabetes self-management. Libre was launched and expanded in the full glare of social media, and particularly in the early days, people only became aware of its existence through online communities. Early adopters like Laura Cleverly taught others about it through You Tube videos, and I for one first saw a Libre on the arms of friends like Abby BrownPhilippa Robilliard and Lindsay Wilson at the first GBDoc get-together in 2015. More recently, Nick Cahm did much to ensure that the NHS availability became much less of a lottery by his relentless number-crunching, and he has continued to be an authoritative voice on all matters Libre on social media.

The success of FreeStyle Libre has taught us much about the value of partnership and teamwork in healthcare. A good news story amidst very dark times.

Note: please speak to your diabetes care team in order to initiate a change to Libre 2. If you have any questions that I haven't answered, do feel free to get in touch via comments, or on social media.




Thursday, 17 December 2020

The Circle of Life - and death

This post is inspired by a poem. As far as I can tell, it's not very well-known. Have a read of it first; its relevance will become apparent if you read what follows. At the end you can click a link and see it being read by a wonderful actor, to whom I am obliquely connected. Read on....

To a poet a thousand years hence

I who am dead a thousand years,
And wrote this sweet archaic song,
Send you my words for messengers
The way I shall not pass along.

I care not if you bridge the seas,
Or ride secure the cruel sky,
Or build consummate palaces
Of metal or of masonry.

But have you wine and music still,
And statues and bright-eyed love,
And foolish thoughts of good and ill,
And prayers to them who sit above?

How shall we conquer? Like a wind
That falls at eve our fancies blow,
And old Maeonides the blind
Said it three thousand years ago.

O friend unseen, unborn, unknown,
Student of our sweet English tongue,
Read out my words at night, alone:
I was a poet, I was young.

Since I can never see your face,
And never shake you by the hand,
I send my soul through time and space
To greet you. You will understand.

James Elroy Flecker (1884-1915)

Fourteen years ago today - 18th December 2006 - was the funeral of my father, who had died on the 9th at the age of 86, after a short period of ill-health. Only hindsight imposes patterns on what at the time can seem like chaotic and distressing periods of life: my father’s death came during an extraordinarily difficult month in what proved to be a prolonged and trying few years in the lives of my family and me.

And yet even at the time I had an intangible sense that all would be well in the grander scheme of things, and that we would all emerge stronger from our trials and tribulations. Fourteen years later I was caused to re-visit the day of farewell to my father in a manner which was positive and life-affirming.

I shall not dwell on the circumstances of December 2006 in this post: the full story is known to family and close friends, but suffice it to say that the death of my father was by no means the most traumatic event of that month, but that all was well in the end, and I look back on that month with gratitude rather than sadness. Had I been on social media at the time, sharing stuff as we now do, there would have been some interesting posts, to say the least.

My father’s death came at a time when my late mother was descending into the abyss of Alzheimer’s - a story I have already shared here. On the day of the funeral my brother and I arrived at her house with our respective families, dressed in black and ready to support her through a difficult day as she said farewell to her husband of 54 years. She answered the door with a cheery smile, dressed in casual clothes and said “Oh what a lovely surprise, how nice to see you all”. It soon became apparent that she had no idea why we were there, nor that he had died, despite our having been there a couple of days earlier with the minister preparing his funeral. My wife and sister-in-law took her to her room and helped her to dress appropriately (she had always been a stickler for dressing elegantly, formally and correctly) whilst gently reminding her of what had happened and what lay ahead that day.

During that minister’s visit two days earlier, despite appearing very confused as to who he was, who we were and why we were all there, she had startled us all with a moment of lucidity by announcing that she would like to read a poem of her choice at the service, reciting some of the words from memory, quoting the title and author in such a way as to enable us easily to identify it by an online search.

The poem concerned (see above) was previously unknown to me and to any other family members, and she was unable to give any clear reason for wanting to recite it (for example she said she didn’t know whether it was a favourite of our father’s or not), but she was particularly keen on a verse which she said summed up how she felt about being widowed.

But have you wine and music still,
And statues and bright-eyed love,
And foolish thoughts of good and ill,
And prayers to them who sit above?

The poem is called To a Poet a Thousand Years Hence by James Elroy Flecker (1884-1915), a relatively unknown English poet and novelist whose premature death at 30 is said by some critics to have been a major loss to literature and poetry. My own rudimentary research reveals no reason why my mother would have known or liked his work, with no obvious connection to her other than a shared birthplace. 

Come the day of his funeral, we were all nervous that mother might make a fool of herself, not least given her intermittent lack of awareness of his death, and her growing penchant at that time for speaking out of turn in an inappropriate manner. However, she stepped up to the lectern with grace and composure, and read it perfectly, with all the same expressiveness that she had shown in her pomp as a schoolteacher and choir mistress. Sadly, this proved to be a false dawn, as she rapidly descended into an unimaginably grotesque form of dementia, lasting over six more years with little quality of life, such that her death in 2013 was a merciful release for her and us.

Life moved on as it does, and I had put the funeral and that poem to the back of my mind, regarding it as a strangely enjoyable day on which my father’s life had been suitably celebrated, with our mother showing what proved to be one of the last manifestations of her true self.

But what goes around comes around in the Circle of Life, and so fourteen years later that poem suddenly returned to my mind a couple of weeks ago in another circumstance that was desperately sad, yet became strangely uplifting. I don't believe that "everything happens for a reason", because if it does there's some pretty perverse reasoning controlling our lives. However, I do believe in being aware of possible benefits even when at first they are hard to see, such that with hindsight, even the darkest clouds can have a silver lining. For me, many events and experiences in recent years have given me good reason to believe in the existence of silver linings.

My return to thoughts of December 2006 happened because of Lis Warren, a woman of similar age to me from Middlesex who has in recent years become a good friend thanks to our shared medical condition - Type One Diabetes. Lis and I got to know each other a few years ago thanks to the growth of an online peer support community of people living with diabetes: our paths have crossed several times at events both real-world and online, and we have many mutual friends. A silver lining indeed. She and I share much more than a medical condition, and in particular we are both lovers of the arts, in particular music; she, indeed, is a musician by profession, a graduate of the Royal Academy of Music and in her working life was an advisor on music education to the Department for Education. Lis and I were two of a small group of people with diabetes and healthcare professionals who set up and ran a project called ArT1st (follow that link to the website) during the Coronavirus Pandemic, which involved gathering and showcasing artistic work in the performing and visual arts produced by members of the Type One diabetes community: patients, carers and healthcare professionals. Working with this small group, some of them already good friends of mine, others new friends, has been the silverest of linings to this locked-down year.

Tragically, as we were preparing to stage a live end-of-year online event celebrating the success of the project, Lis’s husband John died in late November after a short illness, meaning that our close-knit group felt keenly the loss of one of its members’ loved ones. We wanted to add an element to our show as a gesture to Lis, who remained determined to take part in the show, even though it turned out to be on the very day of her husband’s funeral. It was, indeed, John who had thought up the idea of calling it ArT1st with the clever play on T1. Through the good offices of NHS Specialty Advisor for Diabetes Professor Partha Kar, who had set up the project, we were able to secure the services of an A-list member of the diabetes community, actor James Norton, very much a man of the moment thanks to several starring roles in TV and cinema in recent years. James had already proved himself to be a supportive and self-effacing member of the community, and we were therefore delighted when he agreed to read a poem for us. 

But what were we to choose?

At that point To a Poet a Thousand Years Hence came back into my mind. I looked it up, to remind myself of its words, and shared my suggestion with a couple of colleagues from the group. Both colleagues readily agreed that it was perfect. Flecker’s words are both a wonderful evocation of the lasting power and value of the arts and a painful reminder that our time on this earth is short and precious. Returning to them after over a decade I was struck again by how good a choice my mother had made, whatever the forever unknown reason for that choice. I remain surprised that it is not better-known.

Flecker’s words remind us that we only tread this earth for a short time, yet what we do, what we say, what we leave behind us can indeed be eternal. Advancing years inevitably expose us to the loss of loved ones; if we are lucky, we do not experience real loss until later life, but experience it we all must. And as we age, we all start to wonder when and how our end will come, whether we will be left alone, or leave others alone, and what - if anything - lives on after our deaths.

The notion of life after death is a comforting one which sustains many and forms the basis of entire belief systems. We can never prove or refute it. However, of one thing I am more certain than ever: we absolutely do live on in what we leave to others, not in material terms, but in our deeds, our words, the personalities and values that we pass down the generations and, for a gifted few, the works of beauty that we create in art, poetry, sculpture, writings or music. A thousand years or more hence, especially now that mankind has devised such clever ways of preserving all that we produce, we will all live on. We can all now listen to music written and performed by artists long since dead, digitally preserved as fresh as the day they were recorded.

And every time I catch a look in a photo or a mirror and think “OMG, I’ve turned into my dad”, or every time I hear my own children utter words or express thoughts that I myself might have said, I realise that our earthly bodies are custodians not just of a set of genes, but more importantly of values, talents and ideas which can indeed be immortal.

“I send my soul through time and space
To greet you…You will understand”. 

Click here to watch James Norton reading this wonderful poem with the peerless expressiveness of the English gentleman that he is, dedicated to my friend Lis, her late husband John, and the diabetes community.

Note: This post was written with the knowledge and approval of Lis Warren, who has expressed her sincere and lasting gratitude for the love and support of the diabetes community during this difficult time

Thursday, 12 November 2020

It's Getting Better: thoughts for World Diabetes Day 2020

November is Diabetes Awareness Month, and as happens every year in the first half of the month, leading up to World Diabetes Day on November 14th, there is a growing frenzy of activity and excitement in the online world of diabetes. This year, that online world is the only forum in which the diabetes community can interact to any extent, and so this frenzy and hyperactivity seem particularly intense. Moreover, we are approaching the centenary of the discovery of insulin therapy (January 11th 1922), so no doubt next year’s WDD celebrations will be even bigger and better, not least because we can all hope that celebrations will by then be back in the physical world, rather than the virtual one.

Amidst all the frenzy, it’s a good moment to ponder developments in the world of diabetes, in its treatment and care. In so doing it is impossible to avoid noting how much has changed in recent years, and difficult to avoid the conclusion that the pace of that change is accelerating.

My own thoughts at this time of the year are always shaped by the awareness that I am approaching another anniversary of my own diagnosis, my “diaversary”, which falls on December 19th, this year marking 23 years since I was joined for the second half of my journey through this world by my unwanted friend. Any reflections on what is going on in the diabetes world are necessarily shaped by thoughts on the passing of time, and the increasing longevity of my life with diabetes - I have lived around one third of my life, and more than half of my adult life, with diabetes.

So, in the words of the late, great David Bowie’s last big hit before his premature passing, Where are we now?

I find it very hard to resist being bullish in my response, not least given that healthcare in general is under unprecedented logistical and financial pressure from the global pandemic. In saying so, however, I must qualify it with the very significant caveat that my thoughts apply to those like me living in a prosperous country which provides free healthcare for all. I am painfully aware that any bullishness does not apply to much of the world, including parts of the world like the USA where the state’s prosperity should enable universal healthcare to be a reality. So the thoughts that follow are made in the full and somewhat guilt-ridden awareness of my own relative good fortune.

When I was diagnosed in 1997, diabetes care and therapy had already advanced significantly beyond what many of my friends who have lived with diabetes for far longer than me can remember. A good diabetes friend, of similar age to me but living with Type One since the age of 2, has lived from the days of testing by urine strips and injecting with large syringes, to nowadays using an insulin pump and a CGM. He keeps an impressive personal archive of some of the primitive-looking gadgetry that kept him alive in his early days.

My introduction to diabetes came when injection pens with pre-filled cartridges were fully established, and small electronic meters providing rapid and accurate figures on blood glucose level from a finger prick test had become the norm, albeit fairly recently. More importantly in some ways, I came in at a time when advances in insulin types were starting to give far greater flexibility by mirroring with increasing accuracy the workings of the pancreas. Within a year or two of my diagnosis, I had moved to the basal-bolus régime which is essentially the one that I follow to this day. So things were already pretty good for a Type One here in the UK, and I never at any time felt threatened by it; however, better days were to come!

I am in no doubt that the biggest technological advance in recent years has been the arrival of non-invasive blood glucose monitoring giving more than just a snapshot of levels, and giving it in such a way that it can be done unobtrusively, frequently and painlessly: I refer, of course, to low-cost continuous monitoring devices, and in particular to the FreeStyle Libre flash monitoring system. The advances in diabetes technology have been stunning, and are accelerating as they become cheaper in real terms: this mirrors the way that, in our everyday lives, we all now keep in our pockets a mini computer of infinitely greater power, capacity and capability than the lumbering desktop with its hefty CRT screen that sat on our desks back in 1997. 

Commercially available devices have in turn been the stimulus for creativity and amateur expertise which has enabled patients to drive progress towards closed loop systems, with the prospect of a widely available de-facto artificial pancreas now looking more achievable than the proverbial “ten years from now” cure.

Alongside medical technology, information and communication technology has also made an astounding difference to those of us living with diabetes. When I was diagnosed I felt very much “at the mercy” of diabetes, and therefore very reliant on the input of the doctors and nurses assigned to my care. 1997 was very much in the pre-internet age (I first went “online” in early 1998, and as such I was an early adopter of home computing at a time when the internet was seen by many as the province of nerds and teenagers). My knowledge of diabetes at diagnosis was minimal, and beyond what HCPs told me, my only source of information was the printed word in books and magazines. What a different world it is now, with our first port of call on a medical issue being, for better or worse, Dr Google. These days, a person newly diagnosed would be signposted to a vast amount of information, to websites, to YouTube videos, to blogs, to peer support groups and a whole lot more. The problem must be to decide which resource is good, which is bad and which is ugly.

However, I believe that an equally important change in recent years is not a matter of kit and technology, but rather a far less tangible change of attitude on the part of both those living with diabetes and those who care for them. The irony is that this, too, has been driven by technology. There are still some who decry the influence of the internet in general and social media in particular, but what strikes me in the context of diabetes is that people have used technology in a very human and personal way, and that it has built bridges and brought people together in a way that harnesses the best that technology has to offer with the best and simplest of human virtues: friendliness.

Back in 1997, I would never have believed how connected we were all destined to become. I would never have believed that I would be talking, during a global pandemic, to people all over the world in little boxes on my computer screen, or that I could be constantly conversing in real-time written messages with friends. These days, my best source of “breaking news” is my best diabuddy whom I only know because we both have diabetes and started talking about it on Twitter. When anything good or bad happens in the news, or in either of our lives, our first response is to message one another. Many other people with diabetes enjoy similar, relatively new, but close, friendships.

But it’s not just peer-to-peer: we in the UK are privileged to have an online diabetes community in which patients and healthcare professionals interact freely, safe in the knowledge that each has something equally important to bring to the relationship: lived experience on the part of the patient and clinical expertise on the part of the professional. I count myself blessed with the personal friendship of many HCPs whose initial connection to me was through the diabetes community.

The community has no leaders as such, but is led by many: I shall deliberately avoid mentioning names, but we all know that there are doctors, DSNs and pharmacists of national professional repute who freely share their expertise and time online, yet just as importantly they share their lives, their interests, their passions and much more from well beyond their professional lives. Likewise, we all know that there are people with diabetes - and parents of children with diabetes - who freely share the experience and know-how that comes from living with diabetes, yet also their own personalities, their lives, their passions and much more, again from well beyond their lives with diabetes. During the pandemic, we have seen individual initiatives, notably by the organisers of the weekly tweetchat, like Zoom quizzes and the Fantasy Football league, and also larger initiatives like the Art1st Project, run by a coalition of people with diabetes and healthcare professionals. What these have in common is that they are about the people, not the condition, and it is this generosity of spirit that has enabled the community to flourish despite the inevitable fragmentation that has resulted from its growth in numbers. Alongside the partnership between patients and HCPs, the diabetes charities, Diabetes UK, JDRF, and DRWF have also become part of the community, not least through the personal and personable engagement with patients by their staff and leaders.

The blend of timeless human virtues - kindness, sharing, listening - with technology has given us a world unrecognisable from that of only a decade or so ago. Spending so much time alone at home this year, as we have all been compelled to do, I have come quite close to feeling grateful to diabetes for giving me some of the best friends I have ever made. 

When we finally emerge into the post-Covid world - sooner rather than later, we hope - it will be in many ways different, but we can surely hope that the blend of technology-driven remote connectivity and the warm relationships that technology has help to foster will leave us with the best of both worlds.

I was going to entitle this post Where are we now, taken from that rather bleak but wonderful Bowie song referenced earlier, but given that the announcement of a breakthrough on a Covid-19 vaccine came after I had started writing it, but before I finished it, another song came into my head, and I prefer to leave that as my customary song title for this post: the uplifting 1969 classic by (Mama) Cass Elliot which speaks, I hope, of where we are heading in the pandemic, and in diabetes care: It’s Getting Better.

Happy World Diabetes Day, everyone! With thanks to all who are working so tirelessly to support people with diabetes.

People places and events from my world of Diabetes

Tuesday, 25 August 2020

When will I see you again? - Diabetes care and the Pandemic

Six months and counting..... 

As we popped our Prosecco corks with the clock striking midnight last New Year’s Eve, none of us had any idea what 2020 had in store for us. We have now lived for half a year in a period of unprecedented collective anxiety for all but the diminishing number who remember the severe privations and genuine suffering of the Second World War. Our world as summer turns to autumn looks and feels shockingly different to that of last winter. The list of new words and concepts with which we have become familiar is lengthy, and we have all become accustomed to routines, behaviours and attitudes which would have seemed utterly alien to us on New Year’s Day 2020. 

What would I have thought of this selfie back in January?

Tens of thousands have died in the UK alone, and many, many more have suffered, either from the effects of the Covid-19 Virus itself or from secondary consequences such as delayed diagnosis, postponed or cancelled treatments and indeed subtle longer term psycho-social difficulties yet to be fully recognised or understood. 

It’s not exactly been the jolliest year of our lives, and as we enter autumn here in the UK, with the Virus better understood and to an extent better controlled than it was earlier in the year, we are nevertheless facing questions, anxieties and uncertainties well into the future. A life of carefree interaction with our fellow human beings seem a distant memory and an even more distant future prospect. 

For those of us living with other medical conditions like diabetes, there have been well-publicised extra layers of uncertainty, and I for one have found myself more concerned about my own welfare, more careful about my own actions and choices than at any time since my diagnosis almost 23 years ago. In many ways, we who live with diabetes have been very well-served: there has been wonderful support from healthcare professionals in the online diabetes community, who have transferred their habitual enthusiasm and energy to online versions of their normal activities; the diabetes charities have been excellent sources of information and encouragement, despite suffering from significant loss of income and of course the patient community has displayed mutual supportiveness and information-sharing as always. I have been thankful for the online connectivity which we now take for granted, and contacts made through the world of diabetes have been a source of friendship throughout these difficult months, for which I am enormously grateful. 

Before we feel too sorry for ourselves, it is worth pondering what a lockdown of similar extent and severity would have been like in the pre-internet days of the not-too-distant past: no WhatsApp groups, no video calls, no instant online sharing of information, memes and funny videos, no working from home, no remote learning. Even twenty years ago, that would have been the reality of a similar scale pandemic and lockdown. 

If nothing else, surely one of the positives of the pandemic will be to convince even the most grumpy luddites that the information age is an overwhelmingly good thing, and that smartphones, tablets and laptops are a modern-day blessing, a miraculous tool for social interaction and information sharing, whose obvious faults and disadvantages are not the fault of the medium itself, but rather of the human imperfections or evils of those who use them. 

I have taken great delight during the pandemic in chatting over the garden fence with my octogenarian next-door neighbour about stuff he has found on the internet, or how much he appreciated an online video consultation with his doctor. He recently told me that he had bought a Bluetooth speaker and had googled the origins of the word Bluetooth (a 10th Century Scandinavian King in case you’re wondering). I was also delighted to receive a Facebook friend request from another octogenarian neighbour who had signed up and stumbled across me on a neighbourhood group. I really hope that the pandemic will hasten the demise of the “digital divide”, not just in terms of the older generation but also in terms of those afflicted by poverty and deprivation. 

So the pandemic has certainly taught us to value the internet. 

Now I am an irrepressible optimist. It annoys those close to me at times, but I often genuinely find doom and gloom about stuff a greater burden than the stuff itself. And this is definitely true of the pandemic. I have become far more annoyed and frustrated about the epidemic of opinion from self-appointed experts than with the disease itself. So doom and gloom is not for me, and I am already starting to look for the good that can come out of this pandemic. It’s not easy, but that shouldn’t stop us all trying: I was moved to write this post having filled in a survey for Diabetes UK about my experience of diabetes care during the pandemic. 

Here’s the link if you haven’t seen it – a short and easy survey:

I must say that filling it in made me somewhat frustrated, not least because a few weeks ago I had attempted to get some information from my hospital concerning their plans for re-scheduling clinic appointments (my last was in early December), and I received a rather vague reply indicating that I was on a list for a re-scheduled appointment “in due course”. A follow-up enquiry about the potential use of video or telephone consultation was deflected in the classic bureaucratic manner “We are also looking into the option of using video consultation within our service however plans have not yet been finalised”, whilst my suggestion that they might consider using LibreView to share my data was ignored in a manner which suggested that I was proposing something truly subversive and revolutionary. 

Surely, diabetes care is a prime case for the rapid adoption of new ways of communicating and sharing that we have all taken on over the past six months. For a diabetes patient such as me, fortunate at the moment to be living well with Type One, a six monthly face-to-face at the hospital as well as an annual review with my GP is an unnecessary burden on the system, and arguably upon me. A five minute appointment with a phlebotomist at my GP could yield my HbA1c result, and, together with a look at my LibreView data, would form the basis of a discussion which could surely be just as effective remotely as it is in a hospital ten miles from my home. 

Now of course, there are multiple caveats. My own condition is, for now, good, but might not always be so, and there are aspects that cannot happen remotely. Nobody can check my feet, my injection sites, my eyes, and in many ways most importantly, my emotional welfare, over the phone or through a shadowy face on a screen. Some sort of triage could surely be applied to people with diabetes, such that those in most need would be seen face to face, whilst others would be seen remotely. And I am not proposing online only consultations: if we are seen six monthly, then surely an annual face-to-face, with an interim online in between, makes perfect sense. 

Above all, we must NEVER, in healthcare or elsewhere, allow on-screen interactions to replace face-to-face ones. Zoom, Facetime, Skype, WhatsApp or whatever are wonderful, but nothing can get near to replicating the multiple subtleties of human interaction: badly-lit faces in front of a bookshelf cannot convey body language, subtly raised eyebrows, non-verbal reactions, fear, anxiety, reluctant agreement, embarrassment. We are beautifully subtle creatures who thrive on our interactions with each other, and the human physiognomy is a truly wonderful and subtle thing. I for one am longing for a world in which I can once again see people in the real world, out from behind their masks and visors, or out from behind their webcams. I am very glad that I am retired from teaching, as I would have hated to teach from behind a mask, or to teach young people whose faces, whose reactions and responses are hidden by a piece of cloth. 

So please let’s try to take the best of what we have had to get used to during the pandemic, but also be sure to discard the worst as soon as it is safe to do so. I’ve had more than enough of zoom calls already. 

A Zoom Meeting of Diabuddies from across Europe and beyond

My enduring emotion is that of the Three Degrees song which forms the title of this post, and is a plea which applies to my healthcare team, just as much as to the many friends and acquaintances whom I am missing so much: When will I see you again?

Monday, 13 July 2020

"He ain't heavy, he's my brother" - who cares for the carers?

Photo Collage by my friend Lis Warren

It is self-evident to say that we are living through strange and troubling times: you need to be over 80 to have any significant recollection of the Second World War, so for most of us, the COVID-19 pandemic and its associated lockdown is by some distance the most significant, disruptive and worrying collective experience of our lives. We must, of course, be careful not to overstate its impact upon us or our own level of suffering and deprivation: those of us fortunate enough to have unaffected income, a home with outdoor space and the company of others, together with the means and ability to connect with others through the online world should not be tempted too much into the realms of self-pity.  The privations and worries of our grandparents in wartime were infinitely greater.

If we and our loved ones have not (yet) succumbed to the illness, all that has really happened to us is that we have stayed at home, saved a lot of discretionary expenditure on leisure activities and tended our homes and gardens to within an inch of their lives. My own extensive garden has never been so well tended, many of the boxes which were dumped in the loft or the garage when we moved house three years ago have been tidied and sorted, and many a neglected DIY task has been sorted. So despite occasionally feeling sorry for myself, reflecting on missed outings and holidays, friends and family not seen, I have (so far) little to complain about.

Yet for many, it is not so. In the UK alone, a horrendous death toll means that there are tens of thousands mourning the premature loss of a loved one, and tens of thousands more are still struggling to overcome the lingering and in some cases life-changing consequences of COVID-19.

And whilst I, and many others, have had to do no more than just stay at home and forego some discretionary pleasures, many others have seen their workload increase, their working conditions and practices changed beyond recognition and the level of stress and strain hugely increased.

There has been, quite rightly, much said and done to recognise the efforts of our so-called “key workers”, most obviously in the health and social care sectors, but also those who provide our essential needs - the shop workers, the delivery drivers, the teachers, the IT people who have kept the internet running seamlessly, the refuse collectors, those in the media who have kept us informed and entertained - the list is endless. The very least that the rest of us could do was to stand on our doorsteps every Thursday and applaud, however much that at times felt like a rather empty “look at me” gesture, akin to the way in which some feel compelled to modify their social media profile picture in response to some cause or other.

It is, of course, far too early for anyone to write the history of the pandemic, not least as it hasn’t even reached its peak globally, and remains a significant threat locally here in the UK. However, I hope that when we are able to look back on 2020 - let’s hope it is only 2020 - we may at least be able to see it as the start of a more caring society compared to that which appeared to have been evolving in the “take back control” and “America first” world of the past decade or so. Surely, if we have learned anything from the pandemic, it is that there absolutely IS such a thing as society, whatever the late Mrs T meant by her notorious “no such thing” line. We have seen a relatively young Prime Minister, the Heir to the Throne, the Health Secretary and the Chief Medical Officer all laid low by the infection in a manner which reminded us that in the face of a virulent disease, we are all in equal need of the expertise of doctors but equally the care and dedication of all who work in healthcare, from the consultant to the ward cleaner.

We are all links in a very long and fragile chain. Advanced human society is built upon each and every one of us performing a particular and specialised role, and therefore depending on others who perform another equally specialised role, and those upon whom we depend are often those whose role is most easily overlooked - until they are unable to do it.

I remember once hearing - on an “Understanding Industry” course - that in any organisation, the person whose absence is most immediately noticed is not the person at the top, but rather those supposedly at the bottom. In a school, the Caretaker’s absence would be immediately noticed, as it’s he or she who opens the building at the crack of dawn. A Headteacher could be absent for several days without any pupil noticing. In a hospital, the consultant surgeon cannot do her or his job if the laundry people haven’t provided clean scrubs. One could make similar points about every workplace or organisation.

Of course, we must not from this conclude that those at the top - the leaders, the experts, the bosses - don’t matter as much as the rank and file. Of course they do, and surely another thing that we have learned from the pandemic is that we have not, as some tried to argue at the time of the EU Referendum, “had enough of experts”. We need our experts and wise leadership more than ever.

But what we do all need is to CARE for and about each other.

There’s a commonly used Latin expression Quis custodiet…, abbreviated from Quis custodiet ipsos custodes which rightly asks “who keeps an eye on the guards?”, reminding us that even those who supposedly act in our interest should themselves be held to account.

Well equally importantly at all times, and especially of late, is “who cares for the carers?” It’s a very pertinent question: my son once put it very well by saying “Who gives Father Christmas a Christmas present?”

We are all enormously indebted to carers in the broadest sense at present, be they experts working on the longed-for vaccine, scientists and politicians trying to figure out what it is safe and prudent to do when, van drivers bringing our online orders, nurses and doctors tending the sick, pharmacists keeping us supplied with our life-preserving medication, charity employees and volunteers keeping their vital work going in the face of devastating loss of income, but equally importantly the millions doing their ordinary jobs: people like my son and younger daughter working in their schools or my elder daughter helping to keep a major university's life and vibrancy going in the post-corona world, or volunteers like my wife sewing scrubs and masks for the NHS, or a friend of mine who lives with Stage 4 cancer and is using her online voice to campaign for the resumption of full diagnosis and cancer care for others. Then there are also all those whom I have seen and heard just quietly doing their bit, maybe by helping those being shielded, sharing fun stuff online or generally just being kind. These, in the broadest sense, are the carers.

So we must all remember to care for the carers. They are not heroes, and they have no superpowers. They are just human beings, with the same frailty, doubt, guilt, imposter syndrome and anxiousness that we all feel at times. I was moved to write this post after seeing evidence of such things in the much-maligned but essential world of social media. I have in recent times spoken with friends who are on the proverbial frontline and I have seen from their social media posts, public and private, first-hand evidence of the stresses and strains of their lives and work. I have also seen honest online expressions of self-doubt from an eminent NHS consultant and from a friend who is a tireless and enthusiastic advocate for others living with diabetes, who suddenly found herself creaking under the strain. Equally importantly I have seen evidence of supportive acts of kindness towards these people: I have seen those who give care being cared for, and it is surely very important that we all remember that they too have their needs.

So this post is for the carers. It has been my pleasure and privilege in recent years to become friends with many who work in the NHS as doctors and nurses, thanks to my small involvement in the diabetes community, and I have watched in awe as these people - if you are reading this you know who you are - not just do their jobs, but go way beyond the call of duty to ensure that the rest of us are cared for.

My Latin teacher wife thinks that Quis curabit ipsos curatores just about works as a Latin motto for “who cares for the carers?” so there’s a good title, but being me, I also need a song title for this post. How about the Hollies’ 1969 classic He ain’t heavy, he’s my brother. It immediately came to my mind when I saw that much-shared picture of a black man carrying an injured white counter-demonstrator at the "Black Lives Matter" demonstration a few weeks ago. 

It’s a wonderful song, an entire sermon in 4 ½ minutes, all about sharing the burdens of others. 

He ain't heavy - He's my brother

The Only Way is Up: getting the Covid-19 Vaccination

Two days ago, on Monday, 8 th February, I received my first Covid-19 vaccination. I feel moved to post an account of how I came to get it, ...