Reflections from The Dark Side
31 July 2018 | or chickening out
One of Jean-Paul Sartre's witty, light-hearted aphorisms was the spiritually uplifting observation that "Hell is other people". Mind you, for him, other people were mainly French so his point of view is at least understandable. Our change of cruising from sea to inland waterway has given us some sympathy with his rather jaundiced views. Mind you, I've got more sympathy for Simone de Beauvoir. For her, other people consisted mainly of that gloomy bastard Sartre.
Three years we've been at this canal boating malarkey. Three years since we metamorphosed from weather-beaten, hoary old salts, ecofriendly reservoirs of the wisdom of the ages, blissfully drifting around the Med in harmony with nature, into boating Darth Vaders, scouring waterways in motorised Death Stars, hellbent on vindictively dragging all we meet down with us to the inner circles of petrol head Hell and looking upon it as a bonus if we can really screw the environment while we're at it.
In those three years we have matured into the role a little, and it has become apparent that the Inland Waterway Life is not quite as we had naïvely anticipated. That is not to say that we got it completely wrong. Even we would have difficulty with that.
Attentive (and long term) readers will remember that the original catalyst that triggered the decision to change lifestyles was another episode at anchor on a rising wind. The novelty of living in fear of sudden and violent death was starting to wear off. We fancied something a bit more sedate; something a tad more relaxing; something a smidgeon less terrifyingly stressful. The inland waterways seemed just the ticket.
In some ways, our prognostications were right. In three whole years, not once have we had to spend a night on anchor watch. This is hardly surprising, given that not a lot of anchoring goes on in rivers and canals. It's a lot easier to tie up to the side which, unlike an anchor, doesn't tend to drag and wander about in the early hours of the morning. Tying to the side also has the added advantage of not parking yourself in the middle of a narrow channel and thus giving the 120 metre cement barge a choice between ramming itself up the bank or ramming itself up your arse and steamrollering you into scrap metal. In fact, in the whole three years, our anchor has never been deployed in anger. As it happens, it has only been out of its hole once and that was while we were out of the water and wanted to check that it was, indeed, attached to the boat. Just in case we ever felt like using it.
So far so good then.
It's not all completely relaxing though. What you gain by not being vulnerable to the capricious and vengeful forces of nature you can equally lose by the greater exposure to your fellow man. Interaction with others is qualitatively different when cruising the inland waterways than when coasthopping. The latter is like strolling down the street politely peeking into people's front gardens whereas the former is more akin to tromping through their back yards peering in through their windows at the grubby intimate details of their tawdry, squalid, banal, daily lives. From the sea you see the sanitised façade that a country puts on to the rest of the world. From a river or canal you are directly exposed to the soft underbelly of the culture.
This effect is amplified by the fact that although rivers and canals wander through some of the most exquisite countryside to be found anywhere, they also frequently pass through some of the less salubrious areas, desolate industrial wastelands rendered hollow, skeletal and empty by the near extinction of the manufacturing base of most of western Europe. In France these waterways were the arteries of chemical manufacturing, tile making, cement works, felt production, steel making, steel working and logging. They carried raw materials one way and finished goods back the other. Now they are mainly tourist routes or watery playgrounds for dilettante fluvial nomads like us. On the plus side, though, they do act as havens and reservoirs for wildlife.
Nevertheless, as I mentioned above, cruising inland waterways does carry the risk of encountering some of the less savoury aspects of a culture. Such was the case for us in Nomexy. We had moored at an unserviced quay in what seemed like an innocuous enough spot, facing a pétanque ground and opposite what appeared to be the local sports hall cum * community centre. Wooden picnic tables and benches were scattered over the neatly trimmed grass, interspersed with brick barbeque units. So far, so middle class. We had lunch and settled down for a well-earned post-prandial snooze.
I was awoken by a rhythmic knocking, a regular one-per-second thud, slowly insinuating its way into my consciousness. I tried to ignore it, but it persisted so I went outside for a recce. Seated on the nearest table, with his feet on the bench, was an existential challenge to my wishy-washy liberal sensibilities. He effortlessly pressed all my prejudice buttons:
Calf-length combat trousers & khaki sleeveless vest
Extensive tattoos, including face & neck
Bloody great bovver boots
Enough piercings to set off an airport security scanner
All of these reinforced my original hasty and lazy judgement of 'Ultra-right Neanderthal, probably mega-xenophobic and almost certainly of dubious personal hygiene'. I did try to treat this obviously prejudiced assessment with the suspicion and caution that it so patently deserved, but this was made difficult by what he was holding in his right hand and what he was doing with it. **
What he was holding was a bloody great heavy-duty crowbar, about a metre long from its curved hook at one end to the wicked looking angled chisel at the other. What he was doing with it was gouging chunks out of the bench, swinging the crowbar from over his head in slow, regular, sweeping arcs.
This put me in a bit of a quandary. I considered my options. There appeared to be a choice of two approaches, The Authoritarian and The Sympathetic.
The Authoritarian approach involved waving a video camera about and shouting something along the lines of "Hoi vous sac antisocial de la merde! Arrête ça tout de suite. Je vous ai sur le film et j'appelle la police! This had the advantage of being short, quick, simple, and not at all intellectually taxing, which is why this approach is commonly favoured by the editor of the Daily Mail.
The Sympathetic, on the other hand required establishing a rapport with the poor man, who was obviously in the throes of social alienation syndrome, tempered with a touch of OCD and liberally garnished with a jus of bipolar disorder.
The correct response here would be to approach from the side in an obviously non-threatening and reaching-out manner and demonstrate that I felt his pain. After about four hours of soul baring he would see the error of his ways, hug me with thankful tears streaming down his cheeks and take his leave to reclaim his place in society and go on to live a full, satisfying and productive life. This tactic is favoured by Guardian readers who have the time for this idealistic hogwash, blithely ignoring the fact that months, if not years, of effort by dedicated, highly trained professionals have made little if any progress in bettering the lot of poor unfortunates like our crowbar-wielding friend here.
Both of these strategies, however, suffer from a common flaw (aside, that is, from the fact that neither of them actually works) and that is that they would bring us, and the boat, sharply into focus in the spotlight of his attention. This would not be a good thing. Events such as this make you realise just how vulnerable a boat on the inland waterways can be. Even if he decided against deploying his restyling skills on either of us, that wrecking bar would make short work of the windows and paintwork, two-part epoxy notwithstanding.
So I eschewed both The Authoritarian and The Sympathetic gambits and reverted to my default option, The Cowardly. I skulked in the saloon, despite the heat and stuffiness. studiously avoiding eye contact on the few occasions when I absolutely had to come up on deck. Every now and then I would do my Tunbridge Wells neighbourhood watch bit and snoop prissily through a gap in the blinds to see if he'd gone away. After about three hours he wandered off, having reduced most of the seat to kindling.
I still couldn't completely relax, though. How did I know he wouldn't come back at about two in the morning and try his hand at panel beating on the hull? I even spent the night in the saloon fully dressed.
I can't say I'm proud of myself, but at least the windows and paintwork are still intact. Well, they are until we hit the next lock, anyway.
*Enough of your adolescent smut. It's a perfectly good English word. 'combined with; also used as (used to describe things with a dual nature or function)."a study-cum-bedroom"
**I know what you're thinking, and you're wrong. I thought I'd said enough of the smut.
The full, gory details
04 March 2018 | at last
So - surgery all done and dusted. It cost five grand altogether, plus flights. Still cheaper than getting it done in Spain.
And what does one get for one's five grand? Well, quite a lot really. In chronological order:
• Consultation with pre-assessment nurse
• Microbiology tests for MRSA amongst other nasties.
• Pre-operative consultation with surgeon.
• Pre-operative blood tests.
• Private room for one day (as long as you're out by 8 p.m.).
• Pre-operative consultation with anaesthetist.
• Disposable theatre gown and fetching anti-embolism socks.
• Use of theatres and services of nursing staff (Reception, theatre proper and recovery).
• Assorted instruments, drugs and anaesthetics.
• Complementary arm sling in fetching navy blue.
• Post-operative consultation with anaesthetist.
• Post-operative plate of rather nice sandwiches & endless cups of tea.
• Assorted painkillers of varying strengths, including some medium-duty opiates.
• A slack handful of anti-inflammatories.
• Post-operative consultation with surgeon.
• 2 x physiotherapy sessions
• Post-operative INR blood test.
All of this organised and carried out within a two week period. I think they've done this sort of thing before.
Things got off to a bit of a shaky start with the pre-assessment consultation. After the usual questions on medical history and current drug regime, she moved on to lifestyle. "Do you smoke?" she asked.
"Not for 26 years" I replied smugly.
"What about alcohol?"
"Between thirty and thirty five units a week."
This took her aback a tad. I suspect that clinical staff have a very low opinion of patients' veracity when asked questions such as this. I think they have a general modus operandi of taking the proffered answer and at least doubling it. She obviously thought I was in the Oliver Reed/Jeffrey Bernard category or NFJ as it is known.*
She looked at me askance. "What do you mean by a unit?"
"The equivalent of 10 ml of pure ethanol."
This didn't help.
"So what's 30 units in terms of bottles of wine?"
"Depends on the strength of the wine and the size of the bottle." I countered. She didn't seem impressed by this line of analysis. "I'll tell you what" I suggested, "Just put Drinks too much." After that, all went swimmingly.
Apparently, shoulder surgery is a bugger for post-operative pain. For that reason, the anaesthetist used an interscalene nerve block. This completely numbs the arm and has the added advantage of enabling the use of a much lighter general anaesthetic. This is a good thing for decrepit old gits like me as inhalation GAs have a reputation for accelerating the onset of dementia when given to those of us who are already well on the road to ga-ga land. The blocks are also popular with the surgeons as, should the patient start to come round on the table, (s)he still can't feel a thing. I have it on good authority that surgeons find it very difficult to concentrate when there's a load of agonised wailing and thrashing about going on.
The block lasts about 24 hours. This means that when I woke up, my arm didn't. Now this was obviously a good thing given the state it was in. They had ground off a couple of bits of bone and carved away some chunks of capsule. Then for good measure they gave it a good manipulation under anaesthetic. This involves wrenching the arm into all sorts of positions that it really doesn't want to get into, making the MUA a sort of slightly kinder version of the strappado as practiced by the mediaeval inquisition. It still leaves your shoulder feeling like it's just been put through a mangle, but at least it didn't hurt at the time.
These sensory joys, though, had to wait until the block wore off. Until that happened, it was a very weird sensation indeed. The sensory and motor nerves were blocked and so, as expected, I could neither feel it nor move it. This is a strange enough feeling as it stands, but what made it really bizarre was that the proprioceptors were hors de combat as well. These are clever little beasties scattered throughout the body in muscles, tendons and joints. They relay information to the brain that enables it to know where all the different parts of the body are and their positions relative to each other. It is from this that the brain recognizes that different parts of the body exist and that they are part of what the brain recognizes as 'self'.
When the proprioceptors in a part of the body are blocked it ceases to be recognized as part of yourself. The subjective experience is that there is something alien attached to your body; as if some raving psychopath had, just for the Hell of it, removed an arm from a corpse and stitched onto your shoulder to hang there, swinging uselessly. It's a very strange psychological phenomenon. You can look at it and see that it looks exactly like your right arm. You can touch it and see that it's an integral part of your body, but psychologically it's not you. You feel like Boris Karloff in 'Frankenstein'.
This impression is enhanced as the block wears off. Sensation and motor control return erratically and spasmodically. The affected limb behaves itself and follows instructions most of the time but will occasionally and unpredictably suddenly drop or equally unpredictably flick upwards. If you'd put me in a wheelchair I'd have been a dead ringer for Doctor Strangelove.
All this malarkey started about 24 hours post op. After another day or so, things returned to something vaguely approximating to normal. The pain was dramatically less than pre-operatively and the range of movement was much improved although far from what most people would call normal.
Apparently, one of the bugbears of orthopaedic surgeons is that in many cases the degree of success after all their hard work and laboriously acquired skill is, frustratingly, dependent on the pitifully unreliable application and efforts of their pathetically untrustworthy patients. If the patients don't keep up with the physio for months after the procedure then they end up with severely compromised mobility and range of movement. This rather defeats the object of having the procedure done in the first place and plays havoc with the surgeons' stats when the performance data bods come snooping around.
So I'm now looking forward to at least six months of physio and unpleasant stretching exercises. The things I do to massage the fragile egos of the medical profession.
* = Normal For Jersey. Normal For Sark is about three times that.
Whoops! - There go my scruples
02 March 2018 | or 'A crisis of conscience'.
So, having spurned the blandishments of the Spanish ortho I was left with two options – Get it done on the health service in Jersey or go private in Jersey. This, given my working class heritage and left wing Guardianista credentials should have been cut and dried. I had spent my life proclaiming to anyone who’d listen (and many more who wouldn’t) that private medicine was a betrayal of the NHS and a stain on the memories of Nye Bevan and Clem Atlee; a form of class oppression whereby the rich and influential used their power, wealth and influence to jump the queue and ride roughshod over the deserving, powerless, downtrodden poor. For the sake of consistency if nothing else I should have stood shoulder to shoulder with the proletariat and taken my place in the queue.
Well, yeah, but...
It would have been sooo inconvenient and difficult, Dahling. It’s our way of life, you see – it makes things so much more complicated than they are for the common herd. Had we gone through the Jersey Health Service it would have taken an absolute minimum of six months and an endless series of appointments at spectacularly inconvenient intervals. We would have had to write off an entire summer’s cruising while twiddling our thumbs and kicking our heels waiting for the next appointment. Either that or flown back and forth between Jersey and the boat with metronomic and expensive tedium. On top of that, all those flights would have ended up costing us as much, if not more, than one set of flights and getting it done privately.
When principle crashes up against self interest, something has to give.
And in my case it was principle.
I got hold of the contact details of the upper limb and trauma specialist in Jersey and emailed his secretary. Within the space of a few emails we had arranged consultations and a surgery date convenient to all.
I could have made excuses such as that by going private I was helping to ease the financial strain on the overstretched public services, or helping to keep highly skilled and experienced consultants in the underpaid public sector, but that would have been too embarrassingly self-serving and hypocritical even for me.
So I’m just going to put up my hands and ‘fess up. To steal the immortal words of Bill Clinton, I did it because I could. I did it because I happened to be in the rare and fortunate position of being able to lay my hands on five grand without reducing myself to penury and consigning my extended family to a life of Dickensian squalor.
Full, gory details of the procedure have been delayed. To be posted after a suitable period of penance.
“Hypocrisy is the homage vice pays to virtue.”
Francois de La Rochefoucauld (1613 – 1680)