Instructions Not Included

There's been a lot of things said about the Channel 4 documentary 'The Hospital', and its episode on young diabetics. It aired on Monday, and I missed it. I have only just had the opportunity to watch it online, write some things down in my notebook and collect my thoughts.

For those of you who haven't watched it, or are in the US/elsewhere and have no idea what I'm on about, the show was set within the clinic of one hospital, and followed the stories of a group of young diabetics. They seemed to be between 15-26, and all either had complications, or paid little attention to their management. 

Most of you probably know that my background is in theatre. I've been interested in it since I was about five years old, and I've been studying it for the majority of my adult life. So I'm not coming at with no understanding when I make the following observations:

I know why they formatted the show the way they did. 

Drama springs from conflict. This is not a rule that has no exceptions, but for the most part it holds true. Particularly for a show like this. They picked case studies from the extreme end of things - of course they did. It's shocking. It provokes discussion.It's shock and horror for those who know little or nothing about either type of diabetes, and it's a short, hard, jolt even for those who take the management of their diabetes extremely seriously. 

Understanding of such decisions aside, it was not easy viewing. The young people that were interviewed had a variety of issues and complications, all in different stages.

One of the young people followed was Francesca, a 15 year old Type 1. During the programme, the narration told us that it had been months since she had tested. That jars with me on a personal level so badly. If you told me I couldn't test for a day, I would struggle with that. 

A later scene showed her testing, after finding a (what I assume to be) spare meter in a drawer, which said she couldn't even remember how to use (I believe it was an Optimum Xceed, but I could be wrong.). The meter read 'HI', a result that did not particularly seemed to faze her. She then went outside for a cigarette. 

They did show a visit that she had from a community nurse. In general, I don't like to be overly critical of healthcare professionals, as I know that their job is both complex and demanding. However, there are many that you can come across that just don't approach things in the appropriate way. This was one of those instances. If a random reading from your meter is 'HI', then perhaps advising that young person that she might want to think about testing her levels "during the party season", if that's "all right", might not be the best course of action. 

Francesca admits to being a binge drinker. This and under-age smoking bothers me intensely. She says that what she wants to do is "socialise", but this appears to be limited to getting drunk with friends. At the age of 15. I know children are drinking and smoking at a younger age, but this makes me incredibly sad, and I don't want to come across as judgemental, but I would really love to know where the parental influence is in these situations. Where are these children getting money for alcohol and tobacco?

There were only two parents interviewed during this show. Both I found to be infuriating, if I'm honest. Francesca's mother did, in my opinion, have her priorities all wrong. Her biggest concern seemed to be the possibility her daughter's poor control might cause infertility later down the line. This enraged me. I have great sympathy for those who deeply desire a child but are unable to have one, but it is not the biggest tragedy that could happen to a person. Surely having your daughter alive and well is more important than currently non-existent future children? She also said that Francesca had been "left to control it herself, really.". I know, thinking about myself at age 15, I doubt that I would be able to handle the complexities of a chronic illness like diabetes.I'm stunned that she's willing to turn it over to a child in that fashion.

The other mother that they interviewed was the mother of Yasmin, a Type 2 diabetic, who I believe was 17 (please do correct me if I've got that wrong). Her understanding of the way diet and nutrition is such a vital part of diabetes management would have been laughable if it hadn't been quite so alarming. Yasmin was recovering from an abscess in her chest, and had been strongly advised that she needed to lose weight. Her mother served her a large amount of rice and potatoes accompanied with several lettuce leaves and stew, and considered that to be a balanced meal. She also then complained that healthy eating was too expensive. Again, that bothers me. Healthy eating does not need to be an expensive thing. I don't claim to be an expert on Type 2, but there just seemed to so much wrong with that situation

Other cases were shown, such as several young, pregnant women, and a 26 year old with final stage kidney failure, who was waiting for a kidney and pancreas transplant. Other things that were shown were the amputation of a toe, with no warning and in graphic detail. I'll be honest in saying that seeing that made me want to run away and hide.  These were all important things for me to see, and I'm sure for many others. They certainly weren't pleasant or easy things, but seeing what could happen motivates me to make sure that it does not. 

I'm not a believer in scaring people into submission. You shouldn't operate out of fear, because that's no way to live your life. But living with realisation of what could happen, and being motivated to prevent it? I think being armed with the facts is important. Ignorance might be bliss, but knowledge is power. It's unsettling to hear these young people, saying "I haven't thought about the long term at the moment...I'm not bothered". I remember back 10 years and being 15 - at that age, it's hard to imagine being 25, let alone 45, 55, 65. Something has gone terribly wrong in the system though, if at such a young age, your future self and their health is so way off your range of thought that you'd rather "go back to my more important priorities" (which the show implies to be getting drunk with friends).

I know that I've never been a child or a teenager with diabetes. This is actually something I'm planning to write about next week. I don't know what that's like, and I never will. But I refuse to believe that the actions of these teenagers are purely their fault. Rebellion is one thing, but there seems to be something missing. There seems to be the option of education - the programme showed what appeared to be a clinic with multiple healthcare professionals available on what appeared to be a drop-in basis. I don't think it's necessarily fair to expect a young person who is in all intents and purposes still a child to be entirely responsible and pro-active about their healthcare. Some independence can only be a good thing, but somewhere a link in the chain is breaking down. Hopefully programmes like this might be able to start shedding some light on where the problem lies, and how our healthcare system can address it. 

The doctor who was interviewed for this, Dr Richard Savine, has come under a lot of criticism from comments online. He's been accused of being patronising and generalising diabetics with sweeping statements. I personally don't agree. What I saw was a man who has been trying to get through to his patients for a long time, and is tired.  I heard nothing from him that got me worked up, or angered me in any way. Yes, he made comments about other young people looking at young diabetics as "damaged goods". Not the best phrasing in the world, perhaps, but he didn't make out that these were his views. I thought that he seemed to be doing all that he could with patients who did not, for whatever reason, seem keen to listen to what he had to say. 

Admittedly, the narration of the piece left something to be desired. I would have been happier if there had been stronger and clearer explanation of the differences in the two types, and each young person introduced by with the appropriate type, as only Yasmin, the young lady with Type 2 seemed to be identified by her type. I'm not a huge fan of 'diabetes' as an umbrella term. We're all one community, but there are fundamental differences which the public are not always best educated on. Until these differences are explicitly understood by the public at large, I'm of the opinion that the definitions should be repeated. This might take some time, but if we keep on repeating, we might well get there.

So on the whole, I feel that The Hospital has perhaps had a reception that it didn't deserve. It had its faults, and there was definite room for improvement, but if you watched it with the understanding of the type of show that it was, then that brief was filled. It was never going to be a positive, sunny show, displaying people with good management skills handling their diabetes well, overcoming day to day issues, and accomplishing amazing things. I hope that one day that will see the 'light' of broadcast time, but for now? There's not enough conflict in it. Conflict is drama, and drama is what the makers of The Hospital were after.