Starting tomorrow and running all week,09.30 and 11.00pm C4 presents a week of programmes presented by Dr John Mardsen on heroin addiction.Further details on the C4 web site.All I need to do now is to get my 9 year old to set the video.

The weeks programs are centred round 3 opiate users (2 heroion & 1 methadone) going through Detox.

A temporary 3 bedded ward & tv studio have been built to make the programme. The ward area has been inspected by the Healthcare Commission and "meets the required standard" as do the policies/proceedures etc.

An indepth consent protocol has been followed as the service users come under the 'POVA' regs to ensure that they were able to give valid & informed consent.

Its going to be a challenging week to say the least. Hopefully we can breakdown some of the steriotyping. In spite of what some of the press have been saying, its not big brother & there are no contestants.

The learning curve over the last 4 weeks has been more of a cliff than a curve!

Goodness Malcolm, I am off work today, so saw the first programme this morning, with these 3 poor souls settling in for their detox. My heart goes out to them.I hadn't realised this was actually a programme based around your clinic. I hope it goes alright for all of you.

Yes, it is very brave of you (and them it goes without saying).

Will you be in it?

Simon

Now on countdown to this evenings programme.

The programme was commissioned by the C4 Education & Science departments, I needed a lot of convincing that it was not going to be a Big Brother by another name. Steriotyping is collapsing around me!!

We have in total over 70 production & camera crew on the site over the 24 hr continuem. The ward & studio were built over a 4 week period with all but a dozen of the crew arriving a couple of days ago. Saturday morning they rehersed with crew role playing
Sunday morning Darren arrived 1st with Amanda & Alison coming over the course of the day. By the end of the programme this morning ... no more political correctness to be heard, just "I never realised", "I have to rethink my value system" & similar comments.

The programme for me is an oppertunity to challenge misconceptions held by the public. If people move from a negative view to ambivolence it will have been worth it

And yes Simon I think I get to say about 6 words tonight - & I mean 6 words.

I also hope that some of my 'peers' who have been negative towards D5 will move a little closer towards ambivolence, We are not perfect & we are not 'the' solution but for some we are an option.

Regards to all, I will keep you in the loop about breaking news ... tonight its a forensic scientist analysing 3 heroin wraps confiscated by the police somewhere on the south coast.

Very brave of you all at D5 to do this Malcolm, but I wait to be convinced that entertainment is never the prime purpose of tv, much though I love the medium.

I hope there is a good debrief waiting for the participants however it turns out for them and someone is there to protect them from the lower echelons of the mass media who want the inside story. Somebody will have been at school with one of them and be bursting to share memories with the readers of the current gossip mags.

Will tape them as it is far too late to pay attention, but I bet someone in my clinic tomorrow will be saying how good/crap/realistic/false it is.

Malcolm, you looked very handsome. The tie was lovely.

I take your point Jim

Someone will always be ready to tell a lie, tell a story, tell the truth!!
If I thought this was about entertainment (& I thought long & hard) it would not be happening - I've been a nurse for 30 years, I spoke to the NMC, took independant legal advice & lots of collegues outside D5. Its not just the patients & families who are exposed, I also have a duty of care to my staff& I am only too aware that there will be 'professionals' out there who will be cueing up to have a go at us. I dont do entertainment, no one I know thinks its entertainment but yes some people will watch for the wrong reasons, as said in my earlier post, if it makes them think twice about opiate use instead of believeing what it says in the red top papers .....

We went through an extended consent pathway for the 3 patients who are on film which included the issues around family & friends.

The programme legally cannot be shown again for more thyan 18 months after the end of the last episode - they wanted longer ...I wanted shorter.

Because a big chunk of the funding comes from C4 education/schools they wanted some sort of shelf life ..two schools of nursing have asked for a copy so far.

If this is full of typo's its cos I got to bed about 1am & have to be back on site to check what bits of filming they want to broadcast at 05.00 (It is one of the conditions of doing this that whilst they cannot (legally) give me last editorial word - I have spelt it out (in writing) that if I think they overstep the mark & use footage shot here I dont want used, I pull the patients back to the 3 empty beds I have in D5 proper - thats built into the consent pathway.

I should add that I have no control of what has not been filmed at D5 but do keep sticking my oar in - the C4 soliciter who is on site is getting fed up with Malcolm sez.....
ttfn

Malcolm

Havn't seen it Malcolm. However someone on the Ukhra discussion e-mail group I'm on said that it was pretty much watching people being sedated and was worried people would think that detox was not that bad so wouldn'rt be so scared of taking heroin. My opinion is this is unlikely. However it may not make that riveting TV if its like that and there is a valid point that most people do not go through detox using the detox 5 regime.

Thanks Jim

John Marsden should be saying ..
(if he hasn't already - I have not actually seen what you see ... I see all the inpatient stuff at edit stage but not the live chat stuff cos they keep me in a darkened room to wheel out if they want me to talk/answer questions)

Sorry I digress, John will be saying that Detox 5 is an a treatment option for about 10% of those who want to Detox & will include subutex, lofexadine & even methadone reduction which some still do.

Just to reinforce the point I made in an earlier post, D5 did not commission this programme, we were approached & needed a lot of convincing.

I am only too aware of the views that some hold re D5. I hope that those who know me, know I am not a money grabbing private sector nurse who specialises in "walletectomies" (yes it still hurts) but just a profesional, aware of the bigger picture & working in one part of a speciality area.

regards to all

Malcolm
ps sorry if that sounds like a rant but I'm tired and 'fragile'. This is a forum in which (I hope) I both give & recieve support ;o)

Yes you do Malcolm and we value your contributions.

Though I did (and do) find the 'walletectomy' joke funny, it is not front-line nurses such as yourself who exactly rake in the cash in bundles.

Simon

good luck Malcolm

my main point, although I didn't emphasise it was that fromm what I'd heard the programme was at risk of being boring if it was just watching people under sedation. Is this a risk?

I too found the walletectomy joke funny, but not because it was aimed at detox 5, it was just the word that I liked. I also totally understand why it may not have grabbed you in quite the same way.

hI Jim, your right, watching 3 people being sedated is not exactly exiting!

Its not uncomon for us to see brief toxic states due to the sedation ... Detox 5 makes patients into zombies & chucks them out etc.

I think the TV producers were hoping that it would be more exciting ... my team are doing their usual stuff, Im firefighting the Healthcare Commission - what did we do with the knife? Amanda's nurse call button was too far from her bed! What did we do with the 'powder' (I think it was citric but was in the botom of a burn bin by the time I saw it, so difficult to say as I viewed it from about 30cm via a selection of used sharps).

We have been critisised for making Detox too easy in the past but we try to do what it says on the tin!! Keep our patients as comfortable as possible, thats why they come.

One of the most potent parts (that I have seen) is in Darrens biography (shot before coming to us) when he says "at 16, no one sets out to be a heroin addict". Darrens secondary motivation is that people realise that just because someone is on Heroin or methadone they are ot a bad person and that it is possible to hold a job down (I admit he may not be typical but we see many service users who work & we want to break the steriotype).

Tonight is a neurologist talking about opiates & the brain, more family stuff & me talking about vital signs/obs (again! - I think I get a whole minute tonight).

regards

Malcolm

This message has been edited. Last edited by: Malcolm,

Hi Malcolm,
Because I am off work this week, I watched again this morning (and last night) . If Jim is worried about it being boring viewing, I could reassure him it is not. editing together of everybodies wobbly moments makes enough events for the action shots.. (close up of vomit.. Why is the vomit green etc) I would guess the poor methadone patient was only just coming to her worst moments, this morning (at 1 1/2 days after last dose of methadone) so I imagine there will be lots more vomit. I do wonder how much trouble you have treating the heroin detox and methadone detox on the same time scale, given their very different half lives, but I imagine you have experience of that.

The human tales of these 3 are coming across loud and clear, and while that may be a problem for the 3 individuals, it is certainly giving human (and indeed in the main of course very likeable) faces to the stereotypes normally seen.

You are doing stunningly well within your own 15 mintues of fame, in the circumstances Malcolm, as I hope others are telling you. Very nice jacket this morning. And was that another tie? Take care of yourselves.

Hi Malcolm
I agree you were looking rather dapper! But indeed you did not get to say much so far - good luck for tonight (will be too tired this time i'm afraid, will have to tape it)
I think it's fascinating TV, and no doubt they will all wake up soon and become more interestiing. But unfortunatly the journalists have decided there isn't enough to it, and are trying to shock the parents like a Jerry Springer programme = maybe they agreed to it, i don't know, but i'm sure they didn't think they would not only have to suffer it live but also be talked at by Krishnan Guru-Murthy who had no idea how to handle the emotional material his team had knowingly induced.
But I'm really pleased its on and that at least some people are having their negative sterotyped views of heroin addiction revised

I have watched every second of its showing so far. I was concerned over several issues and slightly curious on others.

Initially the title cold turkey is misleading and slightly ina drug culturally way undermines us many individuals who have been subject to brutal none medicated cold turkeys, more often than not in a cold a feotid enviroment with clanging keys for the door locks.

I did think the girls last dose of metahdone looked like more than 60 mg/ml which she had been taking for over 6 years, I thought trying to hastelly reduce a sustained habit as such could leave a very shaky lady. The otehr side was this was the same lady who walked from her house to her dealers to score her last bag, big danger sign when assessing whatlevek of access she has available to her.

the vomiting seemed extreme but predicatable, the girls handlin the process slighlty lacked sensistivity and at times demonstrated, coldness and lack of empathy. i could assume this is a result of individuals short stays at the clinic. The other thing that bugged me was the amount of people walking about and clanging bits and pieces.

So far I have;nt heard anything about after care or pre care, I did observe a rather critical assessment whcih ddidnt seem to play a part in the final dicision to move forward. In some senses the girl with the suistained methadone and benzo habit might not have been a good candidate howvere possiblty filmin dictated an inability to turn back or reassess another.

Pre care, preperation other docu soap sensationalism, doesnt leave much to be desired. teh stop watchs out side the doors makes its look like stakes are bein sur on who last longest.

I would assume Naltraxone implants will before offerd and possibly paid for by channel 5 this is misleading as many people trying to access the service will be shocked to find the get a couple of weeks scripts with the expectation their community will cover the cost if they arent smart enough to head for the free implants offered in Nottingham.

The family ambush seems rather unsupported and mis-coordinated. Its not good to shock people who have been protected by illusion for some many years all in the one program. dtox box; your next or able to do it again

I recorded a dtox many years ago, it had a really funky sound track and captured many up and downs , I lost it to a computer crash, shame really as it was part of a wider installation I put together to mark the occassion.

Malcolm,
What a surprise, here's me in Northumbria chilling out trying to not think about substance misuse then what happens ? I turn tv on and there's your mug on telly.It was interesting and look forward to tonights programme while the dog is roasting slowly in front of the log fire.

This is getting like 'Ain't it Cool News?' the movie review forum that can make or break a Hollywood Blockbuster.

The clinical stuff is good, as is the back story of the patients (but I bet those nurses will never say 'sweetheart' or 'darling' to any patient ever again as they have used up a lifetimes supply already)

THe live stuff is infuriating, shallow, simplistic and patronising and I could cheerfully have throttled Krishnan Guru-Murthy after his closing comments speculated as to the romance developing between Darren and one of the nurses.(&*^$!!)

Maybe balance will be maintained over the course of the week, but it is very risky thing you and your staff have got into.

Malcolm, you come over very well given the time restraints and that you don't seem to have an earpiece to prompt you. (Please keep the suit and tie, I have a dreadful image of you succumbing to the trendy black polo-neck disease)

This message has been edited. Last edited by: jimjones,

Hi all

Thanks for your support, I had a phone conversation with a nurse/hep c worker friend this morning, & decided that if 50% of the 1.1 million who watched on Mon night move from negativity towards service users to even ambivolence its a good result.

Banksey ... Some valid points,
I disagreed strongly with the title - but the Channel 4 people couldn't get their head round the fact that its 1. a term that is not in common use in the UK (guess they couldnt make rattle or cluck sound sexy & 2. D5 doesn't do cold turkey, we do a modified detox to minimise withdrawal symptoms.

Amanda (our referral from CDT said 70mg - our normal upper limit is 80mg - but some rare exceptions for users who are very stable with absolutely no other use (even hypnotics)& for some who may be as low as 20mg we decline admission at assessment because we have 'motivational' concerns. Amandas sensational assessment revalation was what amount of benzo she has 'maxed out' at - not what her current use is (20m nitrazepam). We use diazepam within our sedation/anxiolitic regime, what we try to establish is possible tolerance.

Alison who was still injecting ... I hadnt seen any of the 'bio' films. I have real concerns about the 'pleasure' she got from the last hit, she 'talked the talk' at assessment (Sunday), I saw the film on Monday eve!

Aftercare ... part of our pathway requires the name of the keyworker/counellor/drug worker who will be working face to face (locally) post discharge. I have two staff who work full time doing 12 weeks telephone support post discharge = a minimum of once a week telephone contact with service user including encouragement to work to the planned local support. We had more than 3 patients prepared and consented (I wont go into the consent detail other than to say it was long and detailed with input from Healthcare Commission and independant medicolegal experts). One of the 3 who were expecting to go on TV was pulled at assessment because I was not happy about his 'motive' for doing the TV prog - he is doing detox in main house instead. If I/we (clinical team) had not been happy with the information we had when assessing the 3 now on TV we would have done it with 2 patients. I have seen the stick we are getting on UKhra and have chosen not to opt into the discussion (but for info) D5 is just under £3k not £7k.

Implants - we dont do them, never have, service users who go for one do so of their own choice. I have always been anti implant but am going to visit Jenny at Lifeback & am prepared to revisit my belief system.

Family support - I was very angry about Vivian being put on the sofa alone (I was in a dead sound area waiting to be brought on). Likewise the two daughters. I petitioned for their non appearence yesterday, they were angry with me yesterday morning but the elder one thanked me last night ;o)

I know that it looks like an advert for D5 but thats cos you know where it is. If you listen to what is asid they refer to the Harrogate Clinic - I am getting stick from on high because the programme may impact on admissions/referrals to the Harrogate Clinic acute psyche service (D5 is only one ward in the building - talk about "between a rock and a hard place").

JM is supposed to cover other treatment options in his slots, I am limited in what I can say on air e.g the stuff I did last night about observations ...I could stand on a podium & talk for 30 + mins about what they mean & why we do them. I was given 2 1/2 mins which was cut to 1 1/2(I was told as I walked to the couch) & Yes Jim, your right I dont have an ear peice - Krishnan has earpeice & video prompt, I have only my wits (those who know me personally know I talk too much anyway) ;o) And yes Jim I will continue to wear a suit & tie (I like me ties!!). It may be a generaltional thing but I like to feel I have made an effort. I have no issue for those who dress'casually' but for me its me own personal thing.

I have to accept that we are the specialists, I expect my peers (you guys & others) to be hypercritical (note: as in intensly critical) - To Joe Public this may change some perceptions, we all complain about streotyping.
I was asked if I was prepared to participate in making a TV programme by the Chan4 Educational & Science dept.
I was and am worried but I took a deep breath and took the oppertunity.

Sorry about long post, lets see what tonight brings...they may call big brother reality TV, this is reality TV/real TV or whatever. Not scripted and not prompted. I know that this morning Darren got his challenge dose of naltrexone live. I did not want it to happen because I know thats what the TV people wanted, I spoke to Shaon (ward manager - on the phone whilst the prog was on air) she reminded me I had said before it all started that we do our job as we always do & if it goes out on TV or not, so be it! I had to back off, The staff were ready to give the Naltrexone & Darren was waiting for it.

Banksey if you want more info, drop me an email & we can arrange a phone call (goes for anyone who wants more info)

regards

M

Malcom, would you object to me copying some of what you say to post on another site?