Nice?

I really don't think so!

I had cause to spend the bulk of Friday afternoon at the hospital- The Norfolk and Norwich- and whilst there I encountered the word, 'nice.' It's often thought of as rather a bland word, out of fashion or favour, so much so that schools, following hot on the heels of yet another educational (here-today-gone-tomorrow) trend, have worked hard at consigning the word to the waste bin.

"Too bland; try replacing this adjective with one of its many synonyms, selected from the 'creative' writing wall." Nice try, as long as we don't become overzealous with this fad. Oops, too late! Is it really true that Ofsted are marking down children's creative writing, based in part upon pupils use of this word? Nice! I think I might start using it more often, start reclaiming it on behalf of the nation as 'twere.

So, the hospital! What had happened was that someone very dear to me had been hastened to the place, in order to have some tests done. 'Twas to be hoped that a serious blood clot had not developed. That's the trouble with using rat poison to treat serious ailments, sometimes it turns out that it's capable of behaving like a poison. Who'd have thought it?


Blood. Thanks Steve Koukoulas

Anyway, it wasn't a clot. It took several hours to be sure, but it wasn't, and the staff -those battling to keep the NHS alive- were wonderful, delightful, very nice!

We still don't know precisely what the trouble was, although we might speculate that warfarin (rat poison) isn't helping matters. The final consultant we saw wouldn't commit, or perhaps he thought it better not to over-enlighten his patient. Otherwise, he was a very nice man, very nice!

But, what he did say was quite interesting, enlightening, damning, depending rather upon one's interpretation of what was actually said/meant.

Hopefully, I've already established that the aforementioned patient is being 'treated' with warfarin. The consultant, in his summarising of what he thought might be causing the problem, referred to warfarin on several occasions, but never overly affectionately. He wondered if it might not be the warfarin that was causing other ongoing, interconnected and frequent concerns; struggling, as it has been, without effect to balance the patient's INR. The International Normalisation Ratio is the measure of necessary anticoagulant in the blood, thus the ability of the blood to a) flow effectively through the body and b) still be able to clot in the event of a bleed. The margin for error is quite fine! The consequences of a miscalculation might be fatal!


More blood. Thanks also, to Erika Julin

The consultant stated that he believed warfarin wasn't fulfilling its appointed role, that of helping to regulate the patient's blood-clotting properties. Thus, he thought it about time that a safer and more suitable alternative was tried; there are several options currently available.

"The National Institute for Clinical Excellence," he stated, "usually 'recommends' the use of warfarin, for the regulating of patient's blood." The words didn't exactly flow confidently from the man's lips. I'd suggest that the word, "excellence," seemed almost to catch in the throat, lodge there temporarily, not unlike a wordy alternative to a fish bone. He coughed, perhaps to dislodge the offending 'item,' before 'volunteering' further 'information.' He talked almost buoyantly about the benefits of the alternatives, their increased safety, their considerably reduced need for constant monitoring. It was around this point that the consultant paused...

One might have been forgiven for thinking that some sort of 'invisible' ear-piece might have been in play, one by which NICE might have been able to refocus the man's thoughts- at least his spoken words. Expectations deftly turned upon the proverbial sixpence. Toning down his enthusiasm he thought that rather than "recommend" any of the anticoagulant alternatives he would "write to" the relevant practice, to inform the GP that "alternatives were available." There was an indeterminate period of waffling readjustment, during which at no point was NICE referred to as a bunch of Governmental Accountants.

But, we all know what NICE's true role is, don't we? George Orwell wrote about these sorts of people; he'd have labelled them as something along the lines of 'The Ministry of Truth.'

Rivaroxaban 'is' somewhat more expensive than Warfarin, at £2.10 compared to 5p per tablet, as of 2013. I don't expect NICE will be factoring in the cost of the constant monitoring of any patient who might be subjected to a life of daily rat poisoning. Short term financial gains trumps long-term benefits- disguise the occasional collateral fatality- that sort of calculation.