Some right things and a humility glug

Hoping to head off ‘witch hunt’ commentators and silent but disgruntled medics I sense may be lurking. Valerie Murphy has had numerous opportunities to ‘do the right thing’ over the last four and a half years. Right things and responsibilities. Below is a list of suggested right things based on my observations and experience of the GMC process.

Right things

(a) The early days

  • Say sorry. Your actions may or may not have contributed to what happened but just say sorry. Someone has died. [As a bit of an aside, a key thread running through this interminable process has been the importance of demonstrating remorse and insight. This can only start with with a genuine apology.]
  • Welcome a full and frank investigation into what happened and contribute to it openly and honestly.
  • Scrutinise your professional practice and involve a range of colleagues and others to help think through and understand what happened and why, and how it might be avoided in the future.

(b) Across the investigatory process

  • Avoid trying to cast blame elsewhere.
  • Be transparent, open and honest. Don’t, for example, ‘save’ information like an earlier death to share in a particular setting at a particular time.
  • You have a set of duties to adhere to. Try not to get sucked into shite practices that may be demonstrated by the Trust executive board or others.

(c) Interactions with your counsel

  • Instruct your barrister to treat everyone involved with respect and sensitivity.
  • Take ownership of your position and role in the investigatory process. If, for example, your barrister begins to ask unnecessary or distressing questions of a witness, tap her on the arm and close it down.
  • If something in the evidence upsets you, try and suck it up. The process should enable embellishments and more to be exposed. You don’t need to have your upset recorded.

During the tribunal

  • If particular issues or concerns with your professional practice are highlighted, work out appropriate ways to demonstrate you’ve improved them. Ask for help if you are unsure how to approach this.
  • Try, as much as is humanly possible, to turn up to every day of the hearing.
  • Think carefully about who you ask to be a character witness and make sure they are properly briefed about the importance of this and what is expected of them.

A final reflection is the professional arrogance medics can exhibit. I witnessed this on twitter this week when a discussion effectively ended with non-NHS commentators being dismissed as ‘armchair critics who wouldn’t last 5 minutes in the NHS’. I don’t know at what stage in the education or experience of being a medic this arrogance kicks in (I ain’t a medic). But I do wonder if a glug or two of humility is a good tonic every so often.

 

The tribunal, two book launches and a dream

The five days between the General Medical Council tribunal weekend hearings have gone past quickly really. Filled with thoughts about a family operation (Tuesday/successful), new baby (due last Friday/born at 3am this morning… welcome to the world, Rory Joshua, you cheeky little cutesy), unexpected office move deliberations, the My Life My Choice AGM where the Queen’s Award was celebrated, and more.

Two book launches

Several people at work told me they’d been reading my book. Blimey. My book. I’d almost forgotten about it among the latest GMC hearing knocks, despite two extraordinary book launches last week. The Book Launch Extravaganza organised by Katherine Runswick Cole at Manchester Met on Oct 31. Six brilliant books, including ‘Don’t Cramp My Style’ by Simon Cramp and Kirsty Liddiard’s The Intimate Lives of Disabled People, a brilliant set of talks, discussion and nosh after.

On Nov 2, Helena Kennedy hosted and chaired a launch at Doughty Street Chambers with an all women panel; Caoilfhionn Gallagher, Deb Coles (INQUEST CEO), Helena and me.

It was another wondrous evening not least because of the open, welcoming and relaxed approach by the Doughty Street team who treated it as the celebration it was (a point I’d kind of forgotten en route on the Oxford Tube), and the sense spoken. The audience included family, friends, #JusticeforLB campaigners, journalists, human rights, mental health experts and some twitter legends. Michael Edwards, Dawn Wiltshire, Pam Bebbington and Paul Scarrott attended from My Life My Choice. The highlight of the evening was when Michael E encouraged Deb when she stumbled over the word ‘incredulous’ and then commented “I don’t use long words myself”.

A dream

I dreamed about LB this morning. Only the second time since he died. In the first dream, from what I can remember, I knew he was dead. It was more of an interactional/touching base/trying to prevent me from descending into madness type thing. He was wearing an unlikely bright red jumper.

This time we passed each other in a white corridor which kind of felt like home. I asked him how he was was. In his own style he said not brilliant. He wished he had a job. We sat down on a couple of chairs. Sitting close, leaning in together. Like we used to. I held his hand. There was that quiet intensity and comfort I’d forgotten about.

It took me a few minutes to remember he wasn’t alive when I woke up.

The GMC tribunal

The GMC tribunal continued today with the panel deliberating in private. They will be returning a decision on whether the charges against Valerie Murphy (LB’s responsible clinician) equal misconduct and, if yes, whether this misconduct amounts to a current impairment in her fitness to practice after 2pm tomorrow. Depending on the decision, two further dates may be arranged to decide on a sanction.

I hope she finds it in herself to turn up tomorrow. She was absent last weekend for undisclosed health reasons. I hope I’d turn up to face the music in such circumstances. As much for the family as for my own sense of self worth and integrity. Even if I felt utter shite. As I do.

 

Writing trauma

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I want to write this post as close as possible to giving evidence at the General Medical Council (GMC) tribunal investigating Dr Murphy’s fitness to practice. To capture the essence and rawness of the experience.

The unnecessary and unchecked brutality. And destruction.

It’s a pretty and long detailed account. That is writing trauma.

[I also acknowledge our GMC solicitor and colleagues who have done what they can to try to ease this journey.]

Weeks of dread led to Rich and I setting off to Manchester (earlier than planned) by train on Monday. Summer holiday travel. Young kids and families. Excitement and crisps.

Our summer has been blighted by the timing of this tribunal.

Rosie decided to come too after I was unable to speak to her on the phone on Sunday evening (after writing this post). I simply couldn’t speak.

Stirring up the horror of what happened four years ago now is, as you’d expect, deeply distressing. LB died. He died. The shite we accepted or were made to endure back in the day is harrowing. And increasingly baffling as we grow further from the cosh of typical learning disability offerings.

Following the @JusticeforLBGMC twitter feed on the train we were surprised when Dr Murphy accepted 28-30 of the allegations raised. Not the Dr Murphy we’d so far come across. With so few allegations left to deal with our thoughts turned to the apology I would probably receive when giving evidence the next day. An apology four years in the making. But an apology.

The next morning, we gathered in the hotel minutes from where the tribunal was being held. George and Charlotte left for the tribunal just before 9.30am. I switched my internet off. Witnesses are not allowed to hear witness evidence and LB’s neurologist was due to give evidence before me. Rich, Rosie and I sat around. Anxious and agitated. Rosie followed the twitter feed passing her phone to Rich every so often. It’s fine, they said. Looking grim. The GMC solicitor called to say the 10.30am start for my evidence was looking on time.

Rich answered the phone. I was on the toilet. Again.

We walked up the road. A couple of men with television cameras at their feet were outside the building chatting. On the 7th floor, we were shown to an inevitably bleak witness room. The GMC solicitor and barrister came in and described what to expect.

We waited. There was an unexpected delay of about 45 minutes as the tribunal panel questioned the first witness.

We flicked through photos of LB on Rosie’s phone.

 

“So cute…”

“Look at that baguette he’s holding!” [sob]

IMG_2810Then it was time. The clerk took us into the tribunal room (left). Rich and Rosie sat in the public bit at the back while I was taken to a large desk facing the tribunal panel. It had a white arch level file with over 1000 pages of documentation, glass of water and microphone.  Before sitting I had to read an oath from a laminated coloured sheet. I couldn’t read it without crying. I couldn’t at LB’s inquest. I don’t know why. Maybe it’s such a stark reminder of the horror that is this (public sector generated) experience and the layers of utter shite that have been woven through it since.

The panel chair introduced the people around the table. The GMC barrister checked I’d signed and re-read my two statements which were in the front of the white file. Then it was over to Dr Murphy’s barrister, Mr P.

There was no apology. Our naive optimism was instantly crushed. Mr P asked me to turn to page x in the file and began a meticulous questioning that involved turning backwards and forwards between my two statements in the front of the file and medical records 700 or so pages towards the back of it.

He had a skimpy pile of the relevant pages laid out in front of him. He didn’t have to lob wedges of 1000+ pages backwards and forwards over a metal lever arch file bridge and leaf through numerous pages to find the relevant page, and section of text.

Briefly scanning through pages of painful words about LB’s horrific last few months.

His lightness of documentation and organisation of the ‘cross-examination’ meant he effortlessly lined up question after question after question. I felt I was being repeatedly sliced open with such a sharp knife there was no trace left on the blade.

“If you could turn to page x… Dr J is summarising his thoughts here, in this paragraph. Did he share them with you?”

“He made a phone call to Dr M. Can you remember how long that call lasted?”

“Turning back to page y. Do you recall Dr Murphy introducing herself in this meeting? In your statement on page j, you said…”

“If you could turn to page z of your statement. CTM meetings were held every Monday, you describe them as 10min meetings. Dr Murphy recalls the meetings being much longer…”

“Turning to page a, another meeting you did not attend, the notes state…”

A masterclass in something.

Over time, photos can become defining memories of particular events as the broader context fades away. Under Mr P’s questioning, on the 7th floor of that imposing building on Oxford Street, Manchester, LB’s medical notes became photo-like. It became impossible to think about and answer the questions that kept coming. To think beyond the words I was being directed to on different pages at different ends of the lever arch file. My heart started to thud so hard and erratically I thought it would knock me off the chair. Black edges creeping around my vision made it harder to find or read the notes. I became fearful of fainting and began to doubt my ability to answer questions truthfully.

“I don’t remember.” “I’m not sure.” “I just don’t know…”

Mr P continued asking questions. Apparently at ease with an approach that unsettles,  distracts and confuses. Seemingly oblivious to my distress. No one intervened. I had no representation.

“On page j of your statement you describe Dr M as dismissive, arrogant and distant. Do you think that’s a fair assessment of Dr M’s conduct or is it coloured by what happened?”

“It might be coloured by what happened but I was expecting a knight in shining armour from a lead consultant who would do something.”

“It’s very upsetting for Dr Murphy to hear any patients’ relative describe her as such…”

Something stopped. An almost powerpoint presentation (and I fucking hate powerpoint) started to run through my mind. LB holding a giant piece of baguette on holiday. The indescribable pain of his death. What we’ve endured over the past four years. Dr Murphy suddenly admitting 30 odd failures in LB’s care a day earlier. Rich and Rosie sitting behind me listening to this inhumane and barbaric form of questioning with no recourse to action.

I gripped the edge of the table and asked the panel chair for a break.

The clerk took me to a room on the other side of the building. By this time, I was sobbing and repeatedly asking “How could they do this?” without expecting an answer. She was very kind but couldn’t ‘talk’ to me. I was left on my own with a glass of water and tissues for five minutes. There are no words for how I felt. They don’t exist.

Walking back towards the tribunal room with the clerk the blackness came back and I briefly stumbled. ‘Do not pass out’ I steeled myself. The thought of delaying this foul process was too awful to imagine. There was a delay before going back into the room as the tribunal were deliberating something. I stood in a section of the corridor with Dr Murphy and her legal team. Rich, Rosie and other members of the public were waiting in a different section of the corridor. I stared out of the window. Half seeing the Manchester skyline, Oxford Road rail station. The clock tower. Grey and threatening skies.

We were allowed back in the room.

Mr P started:

“I was asking about personality side of things and dynamics and wanted to ask you a little about your blog…”

And so it went on. The same questions that had been asked, answered and dismissed during LB’s inquest. Pages to manoeuvre. Notes to look at. Mr P didn’t miss a beat.

After two hours it was finally over. We left the building ignoring the television cameras outside and walked back to the hotel.

I can’t make any sense of experiencing harm in a medical tribunal. One held to explore the fitness to practice of our son’s responsible clinician. How on earth can this be possible and apparently acceptable?

And Mr P? You have taken crapshite to a new low.

Postscript: After Valerie Murphy spent the entire day giving evidence (well worth a catch up at @JusticeforLBGMC with a blood pressure warning for being chillingly shit) it became clear my evidence contributed nothing to the defence case. Nothing whatsoever. It was the equivalent of a kicking down a dark alley by a gang of thugs.

Grotesque.

 

 

The victim statement, party and pond re-activity

 

In May, the Health and Safety Executive asked if we wanted to write a Victim Personal Statement that would be shared with the judge in the prosecution against Sloven. They offered support to write it while acknowledging we probably wouldn’t need it. At the time I thought it would be a ‘minor task’. I mean I write, howl and rage on an almost daily basis.

Eight weeks later the statement remains unwritten. Well that’s not strictly true. I circulated a brief draft to Rich, Rosie, Will, Owen and Tom last week. Rosie fed back it was pretty rubbish and contrived (in less brutal words than these).

“Can’t you use an old blog post…?” she asked.

We said we’d talk about it this weekend because we’d all be together for Tom’s 18th party.

The party was on Friday night. It was pretty raucous with a lot of laughter, food and drink. Late evening with the dodgy disco light doing its thing, a Bowie track came on and the room of lively, loud and exuberant 18 year olds became a bit blurry. Rosie was there with a hug. The family grief morse code working as it seems to.

On Saturday morning after a brief party debrief and some groaning about sore heads we talked about the statement and I jotted down notes about what it should contain. This was largely a checklist of Sloven crap actions. We didn’t talk about the impact of Connor’s death on us which is what the statement is supposed to be about.

Later that day, attention turned to the disappeared pond in the front garden. Owen and I dragged the second of two monstrous plants out of the pond and left it sitting upright on the grass overnight. A solid, giant mass of roots, smelly black sludge and detritus with an enormous crown of green fronds that wouldn’t look out of place on a Doctor Who episode.

Rich dug the pond with the kids about 12 years ago now. It was a major operation based on serious pond research. Considerable depth in parts, different levels, shallow shelves for inhabitants to clamber in and out of, grey blankety stuff underneath the rubber sheeting and a couple of plants from an aquatic garden centre in Wheatley. A pond was born.

Life went on. Pond life flourished. We kept the weeds at bay for several years and children from the local primary school visited to see the frog spawn and tadpoles.

The two plants grew. And grew. Life took an unexpected turn. The pond disappeared under the foliage and was largely forgotten about. Apart from a hilarious dog sitting experience a year or so ago when Ned, a husky-cross, went for an unexpected stinky black cool down.

On Sunday morning, I was outside drinking coffee and studying the beached plant which was almost as tall as me and twice as wide. A woman stopped and said primly:

Ah. You’re attacking the jungle. Good! Have you just moved in?
Er, no. We’ve lived here for sixteen years…

She wandered off.

Owen and Tom set up camp in the afternoon for a couple of hours with music, borrowed footwear and gloves, an axe, spade and pair of shears, and the plant eventually disappeared into various bins around the neighbourhood. They later threw themselves into topping up the pond with a hose too short.

It’s incredibly hard to write a ‘personal victim statement’. The impact is unimaginable for each of us in different ways, at different times, in different spaces and with different people.

The fabric of family life continues to be brightly woven with people who didn’t meet LB. Partners, a baby due in November. Life goes on. My camera continues to capture delights. And they are delights.

The moments in between, and occasionally during, remain filled with an unresolvable ache that feels like a rock at the back of my throat or my chest being crushed. I don’t know if people’s hearts actually ache but for me it’s a throat/breathing thing which seems to have a direct line to tear production.

I just miss him.

We all do.

Four deaths, heads and a medical director

Between Oct 2010 and May 2011, four men died unexpectedly in St Andrews, Northampton. All patients in the Grafton Ward; a 20 bed, low secure ward. Bill, one of the four, featured in Under Lock and Key a few weeks ago. You’d imagine that four patients dying unexpectedly within a six month period in the same ward would send shockwaves around St Andrews and wider.

A copy of the investigation into these deaths landed in the Justice Shed yesterday evening. The terms of reference suggest that there was some switched on thinking around these patients’ human rights:

No. The Charity clearly didn’t understand the word ‘independent’ or their obligations arising under Article 2 of the European Convention of Human Rights. The investigation was led by the St Andrew’s Medical Director supported by the Head of Research and Development, Head of Physical Healthcare, Head of Health and Safety Investigations and Head of Pharmacy. About as far from independent as you can get.

Unsurprisingly, there was zero consideration of the four lives that ended, prematurely. The remaining terms of reference were:

The executive summary states:

It was the patients themselves what done it. With their long standing medical problems (clearly untouched by the long term leading specialist care provided by St Andrews at enormous cost to the NHS and other commissioners). One patient had lived there for 18 years. The day before he died, he refused to have his vital signs checked on two occasions.

Whatever way you cut it, this strikes me as a catastrophic fail on the part of St Andrews. “The UK’s leading charity providing specialist NHS care.”

They couldn’t even be bothered to proof read the final report.

The unmaking of a scandal

When we met Jeremy Hunt back in the day (I know), it was a deeply frustrating meeting because he didn’t listen. And insisted that improving NHS patient safety generally would improve the lives of learning disabled people.

He didn’t seem to understand that learning disabled people typically die prematurely. That there is, too often, a lack of value and worth ascribed to certain lives, and the denial of an imagined future. That these factors feed into the ways in which people are treated. In life and death.

He used the Mazars review, which found that less than 1% of the deaths of learning disabled people and older people with mental health issues were investigated, to ask the CQC to review NHS death investigation processes generally. With a ‘focus’ on the deaths of patients with mental health issues/learning disabilities.

Mike Richards, CQC Chief Inspector of Hospitals, made a statement about this review in April 2016. He didn’t mention learning disability or mental health.

A CQC scoping paper (undated) about the review refers to mental health and learning disability once:

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Less than 1% of deaths investigated translated into ‘important challenges around multi-agency working’. Simply extraordinary. The incontrovertible evidence that, in a so called advanced society, certain deaths are simply rubbed out, erased. Again. A double rubbing out.

I’ve not read the review which will be published on Tuesday. The CQC thoughtfully shared the section mentioning LB. This (now amended section) translated less than 1% into ‘less likely’:

The (Mazars) report also highlighted that certain groups of patients including people with a learning disability and older people receiving mental health care were less likely to have their deaths investigated by the trust.

My maths is appalling (just ask Rosie…) but I know less than 1% rings deeply concerning human rights bells. And, you’d expect, demands immediate scrutiny and action.

The writing is clearly on the wall for the unmaking of a scandal. Almost a year to the day of the BBC publishing the findings of the Mazars report. The broader findings of the CQC review will no doubt feed Jeremy Hunt’s seemingly insatiable appetite for all things human factors at the expense of a focus on the erasure of certain lives (and deaths). I hope both the report, and his response to it, prove me wrong.

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Hoovering stuff and traces…

Having a long, very overdue, clear out. It’s an odd one. Bits of LB stuff under, or in, so many piles, boxes, drawers. Tugs, wrenches and memories from the past interrupt the work of sorting. Pulling out one bookshelf reveals 10-15 years or so of a thick fluff. [Sorry]. A strangely soft, dark grey, uneven terrain. Somehow and randomly coating the top half of the skirting board. Sort of gross. But bits of LB. Of Chunky Stan. Of all of us…

It was gone in seconds with the hoover. Traces disappeared.

Odd photos and pictures have turned up. I don’t know who’s with LB in this prom photo (now on the fridge). It’s a school pic. And I’ve not deciphered his film announcement below. The cast includes Dan, his beloved dentist, and Tom, who may be Tom Chaplin from Keane or bro Tom. Depending on when it was produced. He’s rubbed out some of the drawing which was unusual. Or maybe I’m trying to wring too much out of these drops of magic. A way of being with him again. Fleetingly.

LB stars and directs, of course. His casual confidence on display in both pictures.

I smile, cry, chuckle, rage and feel enormous and unchanging love. I bloody love that boy.fullsizerender-15

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The GMC investigation (Part 2)

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Memorial bench lichen at Wolvercote Cemetery. August 2016

Delved back in time to trace the steps of this investigation and it’s worse than I remember. Part 1 covered how, after sending a lengthy and detailed letter of referral, I had to return the consent form to the GMC within 8 days or risk delaying the investigation. Back in June 2014.

So how have the intervening 26 months been filled? 26 months…? Good question.

We started with six weekly updates by letter (good) which tailed off towards the end of year 1.

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Blimey. Another tight deadline for us. Waiting on Sloven as ever. 10 months to get an expert report, get the referred doc to respond and, er, think about what to do next. But at least it looks like the investigation is pretty much finished.

In May 2015 I replied to an email from a journalist saying among other stuff the “GMC should really be any day now (they started last June) and it was at the final decision stage the last I heard, a few weeks ago”.

I look back on these exchanges now and wonder at the utter naivety they reveal on our part. And the (at best) indulgence demonstrated by the – no urgency here, fuck off and wait for as long as it takes, you bereaved families, you – General Medical Council.

The next communication was a letter from a GMC in-house legal person, sent by email on July 15 2015, with this vaguely hilarious subject heading:

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Please respond. That’s all we do. Like obedient (through regular beatings) puppies. Grateful for any crumb of progress. Though this particular crumb was a surprise. Fifteen months after our initial referral:

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What the actual fuck? Why/how does the need for ‘confidentiality’ erase the need for effective and sensitive communication? Is there a collective historical amnesia in operation within these regulatory bodies that means everything that came before is just tossed out with the rubbish? Did no one involved really not pipe up and say something like:

Er, this is a teensy bit awkward given the referral was made over a year ago now. And we’ve led this family to believe that the investigation is pretty much finished. We really should contact them to explain exactly why we are only now collecting statements*.

Nope.

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To be continued.

*We still don’t know.

 

The GMC investigation (Part 1)

Starting a series of posts about our experience of a GMC investigation. I don’t suppose it will be a big surprise to hear that this is utterly shite. I don’t  know what to call it. Journey? Process? Piss take? Shambles? I dunno. You decide. I’ve kind of held off from unpacking this [fill in from above] in case it somehow influences or ‘biases’ the outcome of the ‘investigation’ but have reached a point at which I sadly realise that there is no outcome to muddy, bias or de-rail. Just an inept, unwieldy, careless, brutal, inhumane (no)thing

Back to 2014. When I first referred Dr X after Sloven repeatedly refused to let us know anything about possible staff disciplinary procedures. We got wind that Dr X had relinquished her licence and gone to practice outside the UK.

The referral was harrowing. Having to lay out the reasons why we thought Dr X failed LB (it wasn’t (and isn’t) our job to do so) was deeply painful. Luckily our fab solicitor helped us.

A month later we receive an acknowledgement from our newly appointed GMC investigation officer. Kicking off with a breezy opening:

Thank you for your letter of 22 May 2014 about Dr X.

I will be investigating your complaint and will be your main point of investigation during the investigation.

Note to GMC. We really ain’t complaining about the actions of Dr X. Our son died. Something you seem to erase from this exchange. LB isn’t mentioned until the fifth paragraph. Halfway through the letter:

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This is the grist of the letter. The consent form. Five out of the 10 paragraphs focus on the urgency of returning the consent form. No acknowledgement that someone died. There is no empathy, understanding that we may be in a pretty crap space. The only vague mention of this is towards the end of the letter (before a final demand for the consent letter):

Some people find making a complaint to us a stressful experience… [link to Victim Support]

The irony in this sentence speaks for itself. I think I’ll leave Part 1 here. I returned that consent form before the 27 June 2014 deadline. The only deadline met in this brutal process.

The GMC (are they actually medics?) gave us 8 days. We’re now at 2 years and 3 months with no idea of the end date. Yet another classy bunch.

PS. Hoping I don’t need to spell out the ‘learning’ here but will in a summary post at the end.

Kissing bare feet…

Flew to Helsinki this evening. On a flight with free wifi (Norwegian Air) and a lot of kids. Three little kids just in front. Two younger boys with a slightly older sister who kind of policed them. With a good dose of pummelling, cuddling and arguing. Carefully watched over by their mum across the aisle. Tablets, snacks, learning the Koran (via headphones) and cheeky computer games as the flight went on.

A little girl on the right across the aisle with her mum. And a super cute babe with his mum and dad next to me. Seats 8A, B and C.

A three hour flight. The three kids in front were pretty self sufficient other than the odd headphone war. The little girl to the right slept for most of the flight. She woke when her mum went to toilet, howled briefly, was pacified by her mum who lost her place in the loo queue. Beaten by a man who disappeared for a record amount of time only matched by the smells that emerged with him.

The couple I sat next to operated a pretty much three hour work station between them. Food, cuddles, big white soft toy, love, food, singing, blanket, books, big white soft toy, food, dummy, love, more food. He chuckled, played with the seat table, looked out of the window with excitement, studied the menu, looked at a London guidebook, had a whine, chucked his dummy on the floor, batted the books away, cried, chucked his dummy away again, rocked with frustration, howled and fell asleep.

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His mum kissed his bare feet.

I thought about the kids when they were tots. About that constant space of love, devotion, work, despair, public service, frustration, absorption, protection and completeness.  In between, I read a book about experiences of social change over time (stories from disabled people born in the 1940s, 1960s and 1980s).

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I wondered (again) how the hell we got into a situation in which we took, and left, LB in that hell hole.