Health & Deficiency
08 July 2021 | or 'love and infection'
Oh, the complete and utter irony of it all.
I've spent a year and a half in paranoid isolation, shunning my fellow man, my friends, my family (or what's left of it), in fact virtually all human contact, all in a risible, cowardly, undignified and probably futile, attempt to protect my miserable hide from the big bad virus, only for a bit of sunshine to put my sad, pathetic little arse in harm's way.
That little bit of excess sunshine was all that was needed to persuade some previously law-abiding skin cells to throw all caution to the wind and go off on a frolic of their own, turning an up-'til-then innocent little mole into a slathering, psychopathic serial killer. In the case of melanoma, no-one seems to have pointed out to evolution that killing off your host is not a very effective survival tactic.
They take melanomas seriously in Portugal (Not that anywhere treats them with flippant frivolity). If there's so much as a sniff of one, you're carted of to the local hospital and stood to attention before a bloke with a white coat, a disapproving look, and an aversion to sunshine before you can say 'consultant dermatologist'.
In fact, they take the whole business so seriously that, as the aforementioned consultant dermatologist explained to me in passionate and indignant detail, they have a protocol. This protocol brooks no argument. It is not a set of wishy-washy liberal 'guidelines', it is a set of bloody instructions, and they will be followed. Upon diagnosis of a melanoma:
You will be seen by a consultant dermatologist within a week. He will clear his diary if necessary. In extremis, the round of golf with the chairman of the hospital board will have to go. (1)
You will be subjected to the full range of diagnostic tests available to medical science. Expect every square millimetre of skin to be examined closely and fingers to be waggled around forcefully in your armpits and groin. A full body MRI scan is on the cards if they can get the thing working again with a couple of well-aimed kicks.
You will be CT scanned and x-rayed from head to toe, in the process absorbing enough millisieverts to make you glow in the dark and which will probably cause a couple of cancers of their own as a bonus. Don't mind these. At least they won't be as homicidal as the melanoma.
You will undergo surgery. The original site will be excavated again, only the hole will be longer, wider and deeper, just to make sure. At the same time, your armpit and/or groin will suddenly lose a lymph node or several.
All of this protocol business is obviously beyond the competence of a mere consultant dermatologist. You will have been referred to the national specialist unit for all things cancer, the Instituto Portugues de Oncologia (IPO). This is not some little annexe, hidden away in a back street somewhere. It is not even just a hospital in its own right; It's a whole bloody campus, containing a full-sized hospital of its own and fifteen satellite buildings. It has a concentration of oncological expertise and equipment that is second to none.
It is also in Lisbon.
And therein lies the problem.
The IPO doesn't do house calls. It's a logistical nightmare trying to manoeuvre an MRI scanner down the narrow streets of a village in rural Alentejo and then up the winding wooden staircase to the low-ceilinged bedroom. Even if they managed, it wouldn't do any good. As soon as they plugged it in, it would trip out the power supply to the entire district. If they did, by some miracle, get it to work then the house will be peppered with every ferrous object from a two-mile radius crashing in through the walls. If the donkey happened to be still in its steel harness or the next-door neighbour in his galvanised bathtub then that's their hard luck and they'll get taken along for the ride.(2) No, Mohammed and the mountain and all that. It's a lot easier to move the patient to the IPO than vice versa.
And so it came to pass that we had to get ourselves up to Lisbon. This, I viewed with undisguised panic. In Portugal, in common with most nation-states, the capital poses the highest infection risk in the country. I had apocalyptic visions of having to run the gauntlet of hollow-eyed zombies enveloping us in a fine mist of infective exudate. And as for hospitals, well, I want to keep as far away from them as possible. Very unhealthy places, hospitals. They're full of sick people.
Then there was the little matter of getting there. Neither of us fancied a four-hour drive followed by trying to negotiate the narrow, crowded streets of the capital whilst simultaneously attempting to avoid the predations of hordes of maniacal Portuguese drivers. The Portuguese are normally an easy-going, amiable bunch, but put them behind the wheel of anything and they transform into homicidal raving lunatics who all believe themselves to be the reincarnation of Juan Fangio. They consider the rules of the road to be gross and unjustified infringements of personal liberty while road markings and signs are regarded as advisory at best, and as provocative totalitarian diktats the rest of the time. Their idea of leaving a safe stopping distance between vehicles is to refrain from actually having their front wheels in your boot. A file of cars traveling along a Lisbon street look like a series of dogs, well, dogging, not to put too fine a point on it.
Avoiding this, however, meant taking public transport. This is not an enticing prospect for virophobes such as me. We have tried both coach and train and both have been found wanting.
Wanting, but bearable.
Until the last time.
We had decided to go by train and employed the usual Newbury tactic when faced with a problem, which is to throw money at it. We chose to minimise our risk of infection by going first class. This only costs about five euros more per head per leg, and has two big advantages on the infection control front. Firstly, the extra five euros discourages people from going first class, and so the carriages are more sparsely populated, and the risk of transmission greatly reduced. As a fringe benefit, if you do catch the bugger while in first class, you get a much better class of virus. You know - more refined protein spikes, better table manners and a receding chin. If you get infected with the poshvid-21 variant you end up a facsimile of Jacob Rees-Mogg but without the nanny or the pretentiously named children. Unless, of course, you already have a nanny and pretentiously named children.
Could be worse - could be Boris.
This tactic worked well, and we started the return journey with high hopes that we were in with a chance of coming out of this one alive. There was, however, one factor that we had overlooked. We had to change trains.
The line from Lisbon to Tunes carries intercity trains, replete with comfy seats, buffet car, computer power points, Wi-Fi and virtually empty first class carriages. The hop from Tunes to Lagos is by regional train. This contains uncomfy seats, hermetically sealed windows and is one class only, namely crap class. All laudably egalitarian, but not quite what we were looking for.
As the journey progressed, more and more people crammed into the train at each stop. Virtually no-one got off and the whole train turned into a giant game of sardines. There we were, jammed cheek by jowl with archetypal high transmission risk stereotypes. With iron self-control we refrained from elbowing our way to the door, screaming "My God, we're all going to die!" before jumping off the mobile death camp á la Indiana Jones.
Things got worse. More and more piled into the carriage, talking, shouting, and singing; all three interspersed with the occasional coughing and sneezing. Then came the coup de grâce. The seats in front of us became inexplicably vacant and two women and a boy of about twelve elbowed their way in. The two women wore masks, but the boy didn't. All three of them, though, talked loudly and coughed and sneezed violently all the way to Lagos. This wasn't a railway carriage, it was a gigantic, mobile petri dish.
This is where I lay myself open to allegations of racism and snobbery. I looked around me at the sea of humanity and my heart sank. At least 2/3 of them were archetypes of the popular view of high transmission risk individuals - the poor, the dispossessed and the disenfranchised. They couldn't afford to travel first class even if it were available. They were more likely to be malnourished and more likely to live in overcrowded, less sanitary conditions. Of course they had a higher transmission potential, but this was the fault of luck and circumstance, not lack of moral fibre.
Matters were exacerbated by the fact that the two women and the boy who were hacking, hawking and sneezing in front of us were Roma. All of the comments above regarding fault, blame and circumstance applied to them and then some. Add on to all that the exclusion from the mainstream imposed by human tribal psychology and its integral fear and hatred of outsiders. Concomitant with this is lack of access to health services and social support.
So did knowing all this put me in a good, Guardianista frame of mind, showing my fellow passengers sympathy, understanding and tolerance despite doing the sums and assessing my rapidly growing chances of infection and rapidly diminishing chances of survival?
Did it buggery.
I sat there, seething with fear and hostility, subconsciously willing them all to just get off the bloody train and die. Sod everyone else, what about me? When push comes to shove, then to Hell with your poor huddled masses, it's all down to Me, Me, Me.
Give us five to ten days and I'll tell you how Me got on.
(1) This (completely unjustifiably) assumes that our consultant dermatologist is male. If you happen to be blessed with the services of a lady consultant dermatologist, then she will have to cancel her weekly meeting of the local Kitten Appreciation Society.
(2) The strength of the magnetic field generated by an MRI scanner is almost impossible to get your head round. By way of comparison, a scrapyard magnetic crane, capable of lifting cars, has a field strength of around one Tesla. Modern MRI scanners pan out at up to seven Tesla. Fields of this strength attract any iron or steel objects with immense force. This is called the projectile effect. Several people, medics, patients and technicians, have been killed in MRI units by flying objects. Oxygen tanks appear to be a favourite.