Surgeon Report 6 – Half the man I was

Never let the Wolfman perform surgery. Green stockings. Nice!

It is the crack of dawn on a bright, sunny Tuesday morning. 

I fear I have been conditioned by the hospital system of waking people at 06h00 to take their pills. Either that or the pipework, still very much attached is, dragging me back into consciousness, just like it is dragging my willy in a southerly direction.

I finally feel well enough to sit down and spend a bit of time writing this; the last general ‘thank you mail’ I sent out took me almost an hour to write and was only about eight lines long.

I am still not entirely clear-headed and forget things; what day is it? Did I put on deodorant? (Easy enough to figure that one out!) Have I brushed my teeth? (Ditto, although I think I did do them twice yesterday morning.) I also forget if I have spoken to people and require frequent naps. Maybe it isn’t the anaesthetic; I hear this is what happens to old people.

I am listening to my new Amazon purchase while typing this; Noah and the Whale’s “Last Night on Earth”. On the one hand, it is a great CD, reminiscent of the ‘80s and, unusually, each track is a good one.

On the other hand, I find it a sad indictment of the level of religious education provided in this country. Noah?

So, on to the health front:

The hospital was lovely (thank God for private health care) and all the (mainly South African) staff were an absolute pleasure and looked after me extremely well, even though I threw up on two of them in the recovery ward. I couldn’t talk so asked for a note paper to tell them I was feeling nauseous. Forgetting I was not left-handed, I wrote “sore” and “feel sick”

The nurse said “I don’t know what you have written."

I thought that it was odd that someone who was illiterate would be able to qualify as a nurse until she showed me the page. It was a meaningless, incomprehensible doodle without a single recognizable letter. The anaesthetic was obviously stronger than I thought.

At this point I realised the pointlessness of even trying to explain and threw up on her and the other nurse who was leaning over me trying to read my scrawl.

They took it quite well although I suspect not all the bruising on my stomach is related to the actual surgery.

The procedure took about four hours and was done keyhole, except for the large incision in my side through which they removed the offending parts. The surgeon said that the cut was just large enough to put his hand inside me to grab what was needed. At this point, I wished that I had chosen a petite, five foot female surgeon instead of the six foot guy with massive hands.

The first two days were spent in a self-medicating haze of morphine which, as I mentioned previously, does NOT eliminate pain, it just takes the edge off. Frankly, at times it felt as effective as a couple of Paracetamol.

On Wednesday morning, some homicidal sociopath with ingrained masochistic tendencies and a deep-rooted hatred for men (I think I overheard one of the nurses call her a “physiotherapist”) came to see me to teach me how to get out of bed. I am still not exactly sure what she did, but it felt like she had taken a red hot poker and methodically placed it against each of my wounds. I can say without any hesitation that while this last week was the worst of my life, getting out of bed was the most painful thing I have ever experienced.

I managed to shuffle to reception (about 15 feet away) and back to bed before further branding took place. Then I had to have another nap. According to the brand marking, I am now the property of the Lazy D Ranch.

By midday Wednesday I was eating via my mouth as opposed to via the needle in my arm; I managed four spoons of soup and two spoons of jelly, the latter being obligatory in a hospital. If you refuse jelly in a hospital, people look at you like you just swore in church.

I also had my first bowel movement around this time. I would love to say it was unassisted, but the truth is a rather forthright nurse put not one, but two suppositories up what is traditionally a one way passage. She then ran out the room and ducked behind the door frame before removing a tiny little remote control device from her inside pocket. She crouched down and hit the little red button. Next thing I was airborne. After the cramp and colic, I have never been quite so happy! Who would have thought…?

On Thursday the surgeon came to visit and resignedly waited for me to ask my usual questions. He told me that in all his years as a surgeon, no patient had EVER asked him as many questions as me, which probably explains the £200 consultation fee. He also asked if I was a vegetarian. An odd question, but he said it was not medical and “all would be revealed.” I spent all day Thursday and Friday pondering the meaning of this question and all I could come up with was that he was researching recipes and was going to return my donated organ in the form of a paté.

By Friday I was able to shower and the drain was removed through the hole in my chest. I managed not to look, but it felt like someone had tried to remove my catheter from the inside. As far as I was concerned, the less I knew, the better, and kept my eyes closed throughout the removal process. Unfortunately, when explaining the feeling to a nurse, he cheerfully explained that the feeling in my Netherlands was caused by the 25 cm long pipe which extended all the way down to the lowest point inside my torso, presumably alongside the C. I felt sick.

Being the sensitive flower that I am, I displayed a mild allergy to the bandages and now, alongside my four surgery scars, I have blisters, additional scarring and rashes all across my back and side. Nice.

By Saturday the nurses were tired of pandering to my every whim and demanded that the surgeon authorise my discharge. The drive home was interesting and I could feel every single piece of tar on the road. I don’t remember much about Saturday or Sunday although I do remember sneezing on Monday which set me back three days and reminded me of the physiotherapist.

When the surgeon did come in to see me off on Saturday, it turned out that his vegetarian question related to a small gift he purchased for me; some biltong. What a guy! What a hero! Biltong; my best!

So, if you have read this far, I suppose I should give you the facts. The biopsy and pathology reports came back and confirmed the following:

I had a tumour in the renal pelvis (look it up) and Transitional Cell Carcinoma, which is cancer of the lining of the urinary tract. It was a Grade 2 cancer (out of a possible three) which determines how aggressive it is. It was also (fortunately) a Stage 1 or T1 cancer (out of a possible four) which determines how far it has spread. In my case it had penetrated the surface lining of the kidney but was still completely contained within the kidney itself. Lucky it was caught early! As a result, he is confident that it has been completely removed and that there is no need for chemo or radiotherapy which is jolly good news. I do however have to go for regular annual checks and scans for the rest of my life. It would also be a good idea not to become diabetic although he did say I could eat and drink exactly what I did before.

So, that is where we are today. I am hoping the C will be removed this Thursday after an X-ray to determine if my bladder is watertight. Urgh! It doesn’t bear thinking about, especially if it isn’t completely sealed. I have insisted on prescription strength sedatives (the type usually given to recovering heroin addicts) and a pre-med just to take the edge off the removal.

Right now I am sitting rather carefully in a position that can only be described as ‘legs akimbo’. No one warned me of another side effect; swollen testicles. I feel like I am walking around on a pair of space hoppers.

I have not yet left the flat and my only contact with the great outdoors since the 6^th of June was on the walk to the car from the hospital. I am not quite up to receiving visitors, but perhaps that will change after Thursday if the pipes come out. Please do not laugh at my knee high green stockings. No, I have not become a cross-dresser with poor taste; I have to wear compression socks until the end of the month!

For a morning’s amusement, you could always visit early and watch me try to get out of bed. Imagine a walrus trying to flop itself off a rock and back into the sea. That is pretty much me, but only not quite as graceful.

I sincerely hope there won’t be a Surgeon Report 7.

Surgeon Report 5 – I kid you not

No kid pictures. Goat will have to do.

Most of my post-procedure symptoms lasted quite some time. It made me worry but fortunately I got a call from Webster’s Dictionary's secretary. We had a long chat and told her all my problems (although some had since resolved themselves.

Webmaster himself called shortly after to answer my questions. 

Re weeing like a severed artery at a crime scene 

He said this is quite normal, to be expected and looks far worse than it is. He said it could continue indefinitely until removal (my kidney, not my willy) or could taper off (the bleeding, not my willy).

The good news is that my wee is now like a good oil painting; mainly water-based, but with evidence of rust. Perhaps he left an old pair of scissors inside me during the first procedure? 

What exactly do I have? 

I have Transitional Cell Carcinoma (TCC). By definition, this is cancer of the lining of the urinary tract. The Thing is also, by definition, a tumour, in that it is a tissue growth that should not really be there. Fortunately a soft tissue growth, as opposed to a hard one, which is a good sign! 

Strength 

I am at a GRADE 2 Intermediate stage. Not as good as a Grade 1, but it could be a whole lot worse. Much, much worse according to him!

The GRADE is what is determined under a microscope, just by having a look-see. Perhaps they count tentacles?

They cannot tell what STAGE it is at until the kidney is removed and properly analysed. The biopsy sample is not suitable for this purpose.

The STAGE tells how far along it has developed in terms of laying down roots in the surrounding tissue.

It is therefore good news that it is a floaty sea weedy thing in the liquid which means it is less likely to have laid a solid foundation, something that would have been more likely had it been in the tissue part. 

Benign or Malignant 

Irrelevant, really

Benign just means that it is there, sitting around uselessly, taking up space and being annoying; basically, your average Member of Parliament.

Malignant means it has the ability to spread, so, by definition, what I have is malignant as it can grow and spread.

All previous scans have not shown any abnormalities apart from what has already been identified in my kidney. 

Other 

Further good news is that my cytology results all came back negative. This means that The Thing is either not shedding cells, or is shedding very small amounts or cells with very low levels of annoyance factor / carcinogens / bad 'uns.

After the lady visitor had left my office, I asked him how safe my penis was, vis a vis him having potentially scratched/cut/damaged the pipe work (piep work?) en route to the kidney and then having potentially dangerous cells passing over these open cuts on their journey to the porcelain. He said this was not a problem at all; and even less so based on the cytology reports.

It is clinically normal to separate the biopsy from the removal and space them apart; had the subsequent spread of cells across damaged skin or tissue been a problem, they would not operate (so to speak) in this way.

He also confirmed that had it been necessary to act more quickly (rather than wait the ten days) he would not have given me the option of date or surgeon; he said he would simply have made the necessary arrangements to do it earlier himself or get another surgeon to do it. My opinions or feelings on the subject would not have been taken into account; rather it would have been a clinical decision.

Now we wait.

Surgeon Report 4 – Devilled kidneys

Appetite. Lost.

Ingredients

• 6 lambs’ kidneys, about 375g/13oz, skinned
• 2 tbsp plain flour
• 25g/1oz butter
• 1 medium onion, finely sliced
• 1 tbsp tomato purée
• 1 tbsp English mustard
• 1–2 tbsp Worcestershire sauce
• 4 thick slices of crusty bread
• butter, for spreading
• small bunch of fresh parsley, chopped (optional)
• sea salt and freshly ground pepper 

Preparation method 

• Rinse the kidneys under cold running water and pat them dry with kitchen paper. Using scissors, carefully cut the white cores out of the kidneys and discard them, then cut the kidneys into chunky pieces
• Tip the flour into a freezer bag and season well with salt and pepper. Add the kidneys and toss them until well coated with the flour
• Melt the butter in a large non-stick frying pan. Add the onion and fry gently for 3–4 minutes, or until soft and slightly golden-brown, stirring regularly
• Shake off any excess flour from the kidneys and add them to the pan. Cook them with the onion over a medium-high heat for 2–3 minutes, turning every now and then
• Add the tomato purée and mustard to the pan, then gradually add 300ml/10fl oz of water, stirring constantly
• Bring to the boil, add a tablespoon of the Worcestershire sauce to the pan and season with salt and freshly ground black pepper
• Reduce the heat and simmer gently for 15 minutes, or until the kidneys are tender and the sauce is thickened, stirring occasionally. Add a little more Worcestershire sauce to taste if you like
• While the kidneys are cooking, toast the bread on both sides, then spread with butter and put on four small plates. Spoon the kidneys and sauce over the buttered toast and scatter with freshly chopped parsley (if using)
• Serve immediately while piping hot.

(Recipe and image with thanks to The Hairy Bikers and BBC’s Food Recipes; I could not bring myself to make my own devilled kidneys and photograph it.)

Tests completed, procedures performed, locks oiled, keys cut. Time for action!

I received a call from Webfooted's secretary to confirm that my surgery is booked for Monday; a nephroureterectomy, which is better than a female to male sex change which is an addadictomy.

I asked about the actual biopsy results but at this time, Webtoe had not yet received them.

The hospital called and confirmed that the insurance has been approved for a five night stay so it looks like I will be leaving with my C in place. The only advantage is that I should not need to hang around for hours trying to pee (on tiptoes, holding my breath, trying not to cry) before they release me.

I also had to go for pre-operative testing. Here they give you an ECG, blood tests, blood pressure, pulse, oxygen levels and height and weight. The nurse says the height and weight information is needed by the anaesthetist. I told her the same information is needed by hangmen.

I also had to complete an extensive medical history report. One of the questions was “Are you suffering from any anxiety or do you have any concerns about the procedure?”

I wrote: Catheter. Death. Pain.

In that order. 

Just awaiting actual biopsy results and whether or not I should have my Netherlands waxed before the procedure.

Surgeon Report 3 – Kid knees

(First past) The Post-Procedure Report: (A little referendum joke)

Birthday. Begins with a pipe being pulled from my Johnson

I checked into the rather pleasant hospital (much like the Constantiaberg, for any Capetonians who may be reading. Hi.)

Everyone was very nice and most of the staff spoke with South African accents. A quick meet with the surgeon fish and anaesthetist before being wheeled into theatre. Next thing I knew, I was being woken up in recovery and had a whole lot of blue duct tape wrapped around my Netherlands. A quick glance was sufficient; blankets were pulled back and I tried to un-see what I had just looked at.

I stayed overnight because of the lateness of the procedure and had a rather broken night’s sleep; I was too scared to move or turn over in case I pulled the C.

Was up bright and early and felt well enough to go to work. That feeling lasted about half an hour before I had to lie down and rest again. For the record, having a C removed, even by the nicest person, is not pleasant. The most basic functions, like breathing, suddenly seem to be quite hard.

I was slightly surprised to see one of the nurses wearing a t-shirt that said: “I Love Golden Showers.” I did not even know what that meant until he brought me a trolley containing 82 jugs of water and said “drink!”

400 gallons of water and three pees later for the pervert of a nurse and I was allowed to leave. Peeing after a C has been removed involves standing on tiptoes, constant reminders to breathe in, breathe out while experiencing a hundreds of razor blades passing through you. Each time I went to the loo, the results looked like a crime scene. CSI: Enfield?

Clearly then, returning to work was not an option and a further short nap was required before heading out for a family dinner to celebrate my birthday. With hindsight, perhaps it should have waited until I was more awake. It did not feel like a celebration. Still, nice of Siblings J and G and TLS to pay for my very nice Kulbasti (lamb fillet) dinner. I can heartily recommend Meze Meze (so good they named it twice) in North Finchley.

Earlier, the nurse said that I should keep drinking until the early evening to get the system flushed out, but not to drink too late as getting up during the night and disturbing sleep would possibly aggravate the recovery process. Rather, have a glass of water on waking to get some "back pressure" to force out any blood clots. Horrible!

I decided to ignore him completely.

It is not that I am not a compliant patient, but if I did not drink, and the blood started to clot prevented me from peeing in the morning, I would need to go back to hospital for another C. As this one would not be installed under general anaesthetic, I decided it was simply not a consideration and drank two beer mugs of water before going to sleep to ensure I woke up during the night.

The nurse also said the bleeding would probably persist until the final surgery. I cannot imagine going through this for another two weeks or three weeks; feeling nervous and nauseous every time I go to the loo is not feasible.

So, six days later and I have not managed more than two consecutive hours of sleep. I am a broken man.

Surgeon Report 2 – Kidney Beans

I received a call from the doctor's secretary saying he would like to see me again.

No Value brand for me. But will they help?

The sturgeon fish was at his Enfield rooms next door to the NHS hospital where I had my (fourth) scan. My original private (Harley Street) CT scan took two and a half hours. The NHS version took 3 minutes 59.3 seconds; 0.1 second faster than it took Roger Bannister to run the mile.

I asked the secretary bird if there was anything wrong with my results that he wanted to see me and she said that I should not read anything into it; he meets all his patients, regardless of results, to go over them. She also said he will discuss surgery options at this time which are provisionally still scheduled to go ahead next week.

Meanwhile, I feel like I am back in Brazil where life always provides you with half the story; you only find out the full story once you have reached the front of the queue. Having gone through all this grief, my insurance company does not seem to be prepared to pay for my full surgery; it would appear that they will only pay for half the procedure and presumably want him to just leave the unpaid for loose tubes floating in my midlands.

Technically, the problem is as follows: (Skip this paragraph if you are easily bored by detail)

Mr W wants to do a procedure code 82 which is a laparoscopic nephroureterectomy (I practise saying it regularly to avoid stuttering and making phone calls last any longer than is necessary) which is removal via the stomach of the kidney and the ureter. The insurance company only seems to recognise a code 80 which is a laparoscopic nephrectomy, i.e. removal via the stomach of the kidney only. My concern is that they expect my ureter to remain intact in my innards and float around like a piece of seaweed; surely it would tickle and there would be no way of scratching this one.

Like I don't have enough to worry about...

So, more waiting and arguing. At least I am not in the middle of renewing my cell phone contract or trying to change my bank account, both of which are more stressful than divorce or moving home.

Surgeon Report 1 – Less Kidney, More Pie

Steak Pie. Like me - with no kidney. Tasteless?

For those expecting a sea-going theme, you may be disappointed; this article is not to be confused with feedback on where caviar-egg laying fish are breeding; that would be a Sturgeon Report.

If you read the educational (and musical) “Taking the P!ss”, you will probably be aware that not all is rosy within the temple you know as Fat Al (although the urine certainly has been; or rather rosé.)

I recently returned from a non-fish related surgeon although, this too, should not be confused with Acanthuridae which is in fact a surgeon fish. Frankly, this is even more confusing than Portuguese.

Very nice chap; Mr W, in no rush, sympathetic, empathetic, happy to answer all my questions even though I was there for an hour and a quarter; all very non-NHS. Thank heavens for private medicine. Even his secretary gave me her mobile number so I could contact her after hours! Imagine that?

In case you were wondering why the surgeon is called ‘Mr’ rather than ‘Doctor’, this is a tradition that appeared in the middle ages and lasted until the mid 1800s. Doctors had to study for a degree, ‘Doctor of Medicine’, whereas surgeons learned their ‘trade’ as apprentices to Alan Sugar… sorry, popular culture interfering in the facts… as apprentices to other surgeons.  On passing the Royal College of Surgeons examinations, they were awarded diplomas rather than degrees so they could not call themselves doctors. My surgeon learned his trade as an apprentice to Honest Harry, the Locksmith. This can be the only explanation for how he was able to get his tools through such a small opening to reach my inner bits.

(Note to self: Keep tangents to a minimum.)

After urine tests, blood tests, cytology tests, CT scan, etc, there is no evidence whatsoever of Karl the Kidney Stone who was introduced in a previous blog. That was, for a brief period, some consolation as I could wee almost without fear. A short-lived consolation! Unfortunately, during this screening process, doctors did find an odd-shaped Thing in my right kidney which caused some concern and did ring one or two alarm bells.

Cytology (not to be confused with Scientology, which by virtue of being tax exempt is considered to be a legitimate religion in the USA; a country where the tax office holds more sway than God) did not produce any evidence of malignant cells. However, polymorphs (people who can speak lots of languages) were found to be present which are indicators of an infection.

A subsequent urine test (pop quiz this time – I did not study for it) was done to check for infection but this too came up negative. Odd!

It turns out that The Thing in my kidney – roughly three to four cm in size – is, to put it bluntly, a tumour. It is not in the tissue bit of the kidney (if it was, they could excise it and cut away the surrounding tissues to make sure it is all clear and leave me with at least some functioning organ). Rather, it is in the renal pelvis, which is the sac part of the kidney filled with fluid leading to the ureter which is the pipe that takes fluid to the bladder. It therefore does not have defined borders so cannot be removed on its own as it is sort of everywhere floating in the sac, blocking the tubes and preventing the kidney from draining.

According to the apprentice, The Thing could be one of three things:

1. A non-biological, non-organic kidney stone. Scans and tests thus far rule this out.
2. A fungal infection (fungus growth) which, if it is, could be removed by inserting a tube through the ribs into the sac and vacuuming it out. Sibling G, a vacuum cleaner is… never mind. Mr W said that both this option and option 1 above are so small that they are hardly worth considering. If it was a fungus, it would involve two or three days in hospital and four weeks recuperation.
3. A tissue abnormality. Perhaps this is or could become malignant or equally, maybe it will stay as it is for years to come. No way to tell without further examination.

Irregardless, they have to investigate as man cannot wee cranberry juice on an indefinite basis.

Further CT and MRI scans were conducted, but thus far have not identified any other abnormalities at all and a more recent CT of my lungs showed that they were also all clear of anything nasty which is good news as this would probably have meant chemotherapy before considering organ removal.

The process for further checks generally goes something like this (after the lungs are given the all clear):

Pyelogram
Like a pentagram but for a Jewish Satan. “Ooh, is that a pie?”
Injection of black dye into the kidney; you do not want to know where they put the pipe to inject this dye!
They then flush the dye and then do real time X-rays. As opposed to play time X-rays.

Cytoscopy
This is a pipe with a camera at one end and a large eyepiece at the other. My mind immediately went to the large 35 mm SLR camera I got for my 21st birthday. Fortunately, the camera used in this procedure is just a little bit smaller. A cytoscopy is used to examine the inside of the bladder and (shudder) urethra.

Ureteroscopy
This involves a general anaesthetic and putting a tube up the urethra, through the bladder, up the ureter and into the kidneys for a worm’s eye view of the situation. A number of possibilities then exist…

If they are unable to complete the ureteroscopy (the tubes are very narrow and it is not always possible), they will put in a stent and leave it there. One then goes back for a second ureteroscopy making use of the stent, which will have held the tubes open.

Once they have the scope inside the kidney sac, they will check it out. If there is any doubt as to what it is (say a ‘67 as opposed to a ‘68 Chevy), they will take a biopsy, down periscope and then wake me up. They will then examine the biopsy bits to see exactly what it is before deciding on how to proceed. This is a story for another day.

However, yet another option is; they stick the periscope up and find that whatever is there should not be there; i.e. a sea weedy type thing that is floating about and is definitely, without doubt, bad news, wrong, nasty, giving them the beady eye, out of place, potentially malignant, etc, etc. They then do NOT wake you up but simply roll you over and proceed with the removal of the kidney. (Although the normal practise in one as young as me is to split these procedures)

Basically, the remainification or removalfication of the kidney (in the words of George Bush) is often decided once the patient is already in theatre and asleep.

If a kidney removal is required, the options are as follows:

Option One - An Open Surgery: This is quite old-fashioned and involves opening you up in a large and unpleasant way, sometimes opening the chest and, from what I have read, can involve the removal of a rib to gain access. It is quite painful and has a very long recovery time (approximately 3 months). This is rarely done nowadays unless there is a specific reason for it or they need a specific type of access.

See further down for option two.

Option Three -  A New Way: This is a new surgery and is relatively non-invasive and is less painful and has a much quicker recovery time than the other two. It involves going in from the bottom up and I don’t mean rectally, I mean starting just above the bladder and cutting off the ureter and then moving up to the kidney and detaching it from everything else before removing it from a very small incision higher up in the body. The problem with this option is that it is new and no one knows what the effects will be in 15 or 20 years time; Mr W is reluctant to do this as I am still young. And handsome. He did not actually say ‘handsome’ but I am sure he meant to.

Which leaves Option Two: This involves keyhole surgery; three little holes made around the Midlands and the kidney and ureter detached from everything else via these holes. The bits are then put into a little baggie (NatWest, silver coins only) and pulled down to the stomach. The bag is then either removed via one of the keyholes (I told you he was an apprentice locksmith; you think it is coincidence they call it ‘keyhole surgery’?) or a larger incision (laparotomy) is made in the stomach and the bag taken out this way.

This option involves a five to seven day stay in hospital whilst having a catheter in for 10 days. In a very non-sibling like way, I rapidly did some (correct) mental arithmetic and determined that this would mean that I would have to spend three to five days at home with a ca…, ca…, catheter inside of me. (Owing to a morbid fear of this implement, it shall henceforth be known as a C as I don’t like to talk about it.)

The surgeon fish said “yes”.

Apparently they give you a bigger bag so you can sleep through the night before you need to tap it. Does this man even know that I am Jewish?! Can I not have people in to do this for me? It took all my courage just to leave a urine sample in a small glass jar; imagine a whole bag of it?!

The recovery time for this procedure is four to six weeks with an absolute minimum of three weeks before being able to go back to work. (Whether my car insurance will cover me for driving so soon is another story)

I told him that as worried as I was about malignant cells floating around my body and even the thought of organ removal, my biggest fear was the C-word. (Not that one, I have already explained this!) I asked if I could have the catheter removed under anaesthetic.

He pretended to think about it and then said “No”.

He said it was very quick and while it may hurt briefly, it was not a big deal. He also said there would be some burning when urinating because the skin (?) inside the tube is quite sensitive. By this stage I was sweating profusely, my hairs were standing on end and my testicles immediately packed their bags (bag?) and made their way to my throat; I coughed awkwardly, nearly dislodging one of them.

Before ending this episode, I thought I would leave you with some FAQ.

Is it possible to puncture The Thing whilst taking the biopsy and risk spreading the possibly malignant cells?
Mr W said this was not possible as they were not sending a spike in from outside, i.e. through chest or side; they were sending the scope and pincer thing in internally so no breaking of skin or pulling it out through open skin.

I asked what risks were associated with the procedure, apart from the usual risks of surgery and general anaesthetics.
He said internal bleeding was one possibility, as was damaging other organs. However, he has done loads of these as his speciality and removals are a daily occurrence now. They are considered quite straightforward.

I asked if there were any life changes that would need to be made, viz. diet, alcohol, exercise, etc.
He said none whatsoever. Exercise could be continued when my body felt sufficiently recovered. This is rather good news as I still have half a bottle of whisky on the shelf which would be a shame to waste.

I asked if I could continue TKD.
He said he had never been asked this question before but in all his surgeries, he had never treated anyone for a martial arts-type injury. He says he has had some young rugby players see him for kidney problems, but that, I would assume, is because a 120 kg battering ram ploughed into them full tilt with a shoulder to the kidneys. In TKD we don’t get points for kicking the back so he said it should not be a problem at all.

I asked what follow up medication/procedures would be required.
He said that as I would probably only have one kidney left, (not right), I would need to go for a cytoscopy after six months and then annually. This would be either a local or general anaesthetic where they stick a C up the urethra and examine the remaining bits for evidence of problems. This is a precaution and he said I should get used to being a frequent flyer on Air Urology. He did not say it quite like that although my testicles immediately made for my throat at the mere use of the C word.

As things stand now, it looks like I will be spending my 43rd birthday in Hospital. Expensive gifts are considered de rigueur.

Banksy in Brazil

Unless you have spent the last 30 years with your head buried in a pint (you are English) or in a bowl of heavily sweetened, melted fudge (Brazilian, naturally), you must be familiar with the works of the anonymous graffiti artist (vandal?), Banksy.



Banksy in Brazil

Graffiti is plural; the singular is graffito. The learning curve continues…

Despite holding the view that people who deface trains, walls and buildings (basically, anything that I have to look at and which offends me) should be shot on sight as a warning to other would-be spotty, oik “yoof” artists, I do find his work quite interesting and thought-provoking. This does not show me in a particularly positive light according to Charlie Brooker who said: “...his work looks dazzlingly clever to idiots.”

While much of Banksy's work relies on the visual, he has been known to put forward his views in various books, in this case, ‘Wall and Piece’ where he provides a summary of people who should be shot:

“Fascist thugs, religious fundamentalists… and people who write lists telling you who should be shot…”

Uh oh!

I certainly do not have grounds to complain about his 2003 exhibition “Turf War” where he painted on animals. Once, while under the influence of a very persuasive bottle of Jim Beam, I coloured in a dog belonging to the owners of a house I was looking after. While the RSPCA declared the conditions of “Turf War” suitable for the animals, I am ashamed to say no such approval was given to my early artistic scratchings. In my defence, I was young and the dog emerged without any permanent damage or psychological scarring. I cannot say the same for the owners of the house as we had also labelled the entire contents of their kitchen. Still, they shouldn’t have had any difficulty identifying the fridge after we left.

While a poster of Banksy’s fake £10 notes was sold at Bonham’s for £24 000, the dog could not be given away.

“We can’t do anything to change the world until capitalism crumbles. In the meantime we should all go shopping to console ourselves.”

            Banksy, "Wall and Piece"

Which brings me to the point of this story. I took this photograph of a work by Banksy* during my Brazil holiday and am selling copies of the image. Purchase requests by way of the comments page please.

* Please note that this particular image is by Banksy Liebowitz, my second cousin.

Crime and Punishment

A quick browse through my old holiday snaps revealed this rather gruesome image.

Crime and Punishment. Brazil-style

Despite Brazilian drivers having a slightly more than laissez faire approach to the rules of the road (“que?” being the usual response), they do take offences by motorcyclists quite seriously as can be seen in this picture.

These two hapless motorcyclists were caught driving under the influence of doce de leite and received the ultimate sanction from the authorities. Their heads were placed on stakes as a warning to others who may be tempted to mix sugar and driving.

You have been warned!

Taking the P!ss?

Final Destination

Blood on the Dance Floor: Michael Jackson

Blood on the Fields: Wynton Marsalis*


Blood on the Tracks: Bob Dylan


Blood on the Sand: 50 Cent

Blood in My Urine: Fat Al

What the... Uh oh! I hope my medical insurance covers this. Looks like Harry the Hernia and Karl the Kidney Stone are on a first-name basis.

Time for some medical research. But first let me drink these eleven glasses of water.


Good wishes can be added to the comments page.


* Winner of the first Pullitzer Prize for Music in 1997. Who says you can't learn from these blogs?

The Science of Traffic

After my recent trauma (driving in Sao Paolo), it has been something of a pleasure driving in this quaint, quiet, traffic-free backwoods village we call London. Comparatively speaking.

Pig Taxi. Still no quicker to work

I have however noticed something strange on my journeys to work that may be of interest to Stephen Hawking or perhaps Dr Emmett Brown? (Shame on you if you need to look up the former and not the latter!)

When I leave for work at 08h30, I arrive at 09h30

When I leave at 08h45, I arrive at 09h40

When I leave at 09h00, I arrive at 09h35

It would appear that the later I leave, the less time it takes me to get in.

Tomorrow, I plan to leave for work at 10h00 and, if my calculations are correct, I should arrive before I left.

The Brazil Chronicles Vol III: What doesn’t kill you…

Jungle on Sea

Tanned Al here (sort of – it faded overnight)

160 million Brazilians and I am the only person driving at the speed limit.

Just returned from four lovely days at the coast.  Left Sao Paulo on Sunday, slightly later than planned (i.e. on Brazilian time) after doing an oil, water, tyre and petrol check. Fortunately we had professionals on hand to do this so we did not end up with water in the oil reservoir or petrol in the spare tyre. Not mentioning any names...

The drive to the coast is only about 80 kms, but we were going to Litoral Norte (Literally literally north) which was another 100 kilometres following the coast line north towards Rio. It poured the entire way with windscreen wipers on full, and that was before we hit the mist and fog on the Imigrantes Rodovia (Literally: I would rather emigrate than have to drive this highway again).

The speed limit varied from 60 – 110 but I was doing about 50 just so I could see what was going on ahead in the mist. Meanwhile, the lemming-like Brazilians were doing a brazilian miles an hour overtaking me and disappearing into the mist ahead, possibly to make it safely to their destinations, or possibly to plummet over the edge; who could tell in that weather. To give you some indication of the highway, I have included a few pictures of the massive bridges that spanned the valleys and an entrance to one of about 8 tunnels that drop down through the mountains so quickly and steeply that your ears pop.

(Typically, the pictures have not come out. As they are Brazilian pictures, maybe they will arrive later? Feel free to Google if you are bored.)

There are two main highways, Imigrantes to get to the coast, and Rio Santos which follows the coast all the way from the first main coastal city from Sao Paulo, Santos, all the way north to Rio. On this 150 or so kilometres, there are about 180 speed cameras and, probably in a first for motorway technology anywhere in the world, speed bumps! A typical 500 meter stretch of road would have a speed limit sign saying 80, then as you approached the gentlest of bends 50 meters further on, a sign saying 60, then 80 as you exit the bend until just 20 meters further on, a sign saying speed camera ahead and then a 40 km/h sign followed by two speed bumps and a camera. Interspersed would be an assortment of signs warning children to be fastened to the back seats, not to drive on the hard shoulder and to have your teeth checked regularly, courtesy of the Sao Paulo Dental Council. Brazilian cars do not have cruise control as you can never travel more than about 100 meters before the speed limit changes and both the software and the car would crash within minutes of activation.

Between Imigrantes and Rio Santos lies the town of Cubatao (Literally: Breathe in and you will die). This is apparently the most polluted place in Brazil and a centre of heavy industry. It looks like the English Midlands Black Country at the turn of the century during the height of the industrial revolution, but without the charm, vibrant colours and fresh air. Imagine Epping but 10 000 times bigger and dirtier. We were fortunate that we were making the journey on a Sunday as there were not many trucks and all the traffic was heading in the opposite direction as the Paulistas made their suicidal drive back to the city for work on Monday. Meanwhile, the rain continued.

(Aside: The time now is 11h45; I asked TLS what time her cousin was coming to visit and she said “11h00”. This while she was in a towel and brushing her teeth and at least 20 minutes away from being ready. In a monument to redundant questions, I asked if her cousin was Brazilian.)

After leaving Cubatao, we joined Rio Santos, or BR 101 or SP-55 or Rodivio Dr Manoel Hyppolito Reggo. Apparently, in Brazil, when people can’t agree on road names they agree to disagree and use everyone’s suggestions. Nice and friendly but it can crash your satnav! Assuming of course you can afford one; they tend to cost more than cars.

It is absolutely amazing to see the small villages and towns surrounded by the tropical forests that creep right up to their borders. It is so dense that it is impossible even to walk through; at one point we were walking in the rain but the trees at the guesthouse were so dense we did not get wet.

The highway runs alongside a number of beaches, mainly occupied by holiday homes and locals who look after the holiday homes and an entire industry that survives on the few weeks during the year when one quarter of Brazil’s wealth is concentrated on this stretch of coastline. Usually during carnival and school holidays when everyone makes the trek to the coast, much like the Vaalies going to Durbsbythesea and the matrics going to Hermanus in December. Just more people and more money.

The first beach we came to was Juquehy (Literally: Don’t even think about coming here unless your net worth is £5 million.) How else can you justify your little restaurant on the beach charging £7 for a beer or £20 for a starter portion of calamari, or Lula as it is known locally? TLS’s friend L and her husband Gyro (the guy who doesn’t fall over?) have a family holiday place in a condo opposite the beach and have invited us to stay when we are next in SP. I shall start saving now. L is pregnant and to give you some idea of ridiculous Brazilian prices, it is cheaper for her and her husband to fly to New York and pay for accommodation and buy all the children’s clothing, buggies (boogies if you are Brazilian) and accoutrements than it is to buy in Brazil. The beach is 3 kilometres long, white sand and reminded me of Gillian when she was a teenager – crabby. You have to watch where you leave your toes. We spent a little time sitting on deck chairs and reading in the sun. My Kindle does not reflect. Nice.

Our guest house was located in Camburizinho or Little Camburi (Literally: Of course we lied when we said it was walking distance to the beach you Gringo tourista)

Turning off Rio Santos (and all the other names), left inland instead of right toward the sea, we drove the kilometre or so over a waterlogged, muddy, rutted dirt track to our Pousada (Literally: Please don’t put toilet paper in the toilet, use the bin; we still use an old septic tank and yes, we do know it is disgusting). Portuguese is a amazing in that whole sentences can be translated into a single word. The place we stayed was called Pousada de Coucou, named after the septic tank and coconut trees that grow in abundance in the area. Or perhaps Coucou the black Labrador? Coucou had an unnatural attraction for tennis balls and even with one in her mouth would try and get grab the others. She had a white Labrador daughter called Crystal who also lived there, although Crystal spent most of her time lying across the reception entrance with her legs in the air. Slut!

Our chalet was very nicely kitted out with a downstairs lounge with TV, toilet and small kitchen and a private army of mosquitoes; out the back door was a veranda with braai area. Upstairs was the bedroom (air conditioned) and a small, elite Special Forces mosquito brigade and a large balcony with a hammock or “rede” pronounced “hedge-ee”. This should not be confused with “rede” pronounced “hedge-ee” which is a wireless network for your computer. The last thing you want is to come home and find your computer strung up across your balcony.

They had two swimming pools, one heated and one normal but 25 m long so great for training. I watched a lot of other people training. Before you could swim, you had to shower in the outdoor shower or “duca” to wash off any sun cream or “autobronzant”. These were absolutely freezing. On my way to the shower, I passed two penguins walking in the opposite direction and the one was saying to the other: “forget it buddy, I would rather not swim than stand under that bloody shower!”

Breakfast was included, as was a constantly stocked fridge with beer, mineral water and Guarana, the local drink, not to be confused with Guano, which is an entirely different predilection and one which we shall not discuss on the Sabbath.

They had a nice little breakfast room, and on entering, I could see why Brazilians consider this particular guest house to be more of a health farm; the doce de leite came in a small jar instead of the usual 5 liter tub.

Day two was spent wondering if the rain would ever stop and a brief visit down another dirt track to a pizzeria. Once two American tourists and their guides left, we were the only people in the restaurant. Still, a pleasant evening with nice friendly staff, and probably the only place along the entire 180 km highway where it was not necessary to put your house up as security for your food bill.

Tuesday brought enough sun to go back to the beach so we did Camburi which is beautiful with white sand and looks like somewhere in Thailand with the tropical forest coming right up to the sand and lovely green islands just off shore. TLS says there are no sharks on this coast, just plenty of crabs.

(Further aside: I fear we may have rhinoceros in our gene pool. Perhaps a great, great grandfather? I mention this as I have a single but substantial rogue eyebrow hair that periodically appears in the centre of my forehead that feels like steel when I try and pluck it. I am worried that if I leave it to grow, it will leave me at the mercy of poachers.)

Days three and four were much of the same; lazy breakfast, count mosquito bites, apply a repellent called "Off" which seems to be like perfume for them (I think they missed out the first word on the label), nap, go to beach, come home, shower, nap, find somewhere for dinner. All very pleasant and relaxing. In Portuguese, relax is pronounced “he-la-shee”. God only knows how it is spelled; probably “Pfghjkgfsdg”. Despite being in the forest area, there was not a lot of wildlife to see and no capivarras. They used to have woodpeckers in Brazil, but they all left because they got tired of saying hatch-a-chach-chach instead of rat-a-tat-tat.

The time passed far too quickly and on Thursday it was time to come home. This was also the first day that the sun shone unashamedly and by 10h00 it felt like 40 degrees. I wore my black t-shirt. We agreed to leave at 13h00 to get home in time to shower, unpack and make it back to Tanya for her birthday supper. So we got in the car at half past two.

We reversed our journey over the perilous “perigosa” (Literally: Your perineum will shrivel in fear) roads except this time we shared them with the trucks plying the trade route from Cubatao and Cubatuba, Ubertuba (German?), Tubatuba (So good they named it twice) and Innertuba (I made that one up; maybe more than one). There are signs on the motorway that say “Trucks and buses – obligatory to stay in right hand lane”. These are viewed with the same level of enthusiasm as the speed limit signs so the slowest truck would be in the right lane, the second slowest would take eleven miles to overtake it in the second lane, the third slowest truck would overtake the second slowest in the third lane which would also take 11 miles to accomplish and all the cars would be forced into the far left (fast/suicide) lane and try and squeeze between the last truck and the barrier – hard shoulders on Brazilian motorways are used only by pedestrians and cyclists. And the occasional horse.

Just as we got to the Sao Paulo city limits and passed the overturned security car in the latest downpour, TLS realized that Thursday is Rodizio day. In order to cut congestion in Sao Paulo, you are not allowed to drive your car on certain days of the week, the day depending on your registration number. As our registration ended with an 8, Thursday was our day for not driving. We decided to go straight to T in the hope that we had avoided the cameras rather than go all the way through the city to change. We were late anyway.

We abandoned the car at T’s flat and got a lift to pick up P at his school. There is a coned off lane for parents to use. Lots of security and when you are identified, a woman with a microphone calls the relevant child to leave the departures hall; they even have people to open and close doors and make sure you get away safely. And this is just a middle class public school. Apparently at private schools, the security is much tighter as the threat of kidnap increases.

Took P to his guitar class where we listened to Sweet Child of Mine by Guns and Roses for a solid hour and a half before going back to T for a supper of cheese, cold meat and assorted pies and quiches. Portuguese is confusing as Turkey is Turkey and Peru is Peru, but turkey is peru. P tried to teach TLS to play Sweet Child of Mine.

We eventually left there at about midnight and traffic was still heavy enough to block the four lane wide main avenue through central Sao Paulo. Finally got into bed at about 2 am, completely knackered.

Today we went to the doctor and had the car washed after the 440 km epic journey. I now feel qualified to race Formula 1 after negotiating Sao Paulo traffic and Brazilian motorways. I drove as TLS discovered that her Brazilian license had expired some months ago. I fail to see why this should be an issue as, in my experience, most Brazilian drivers have never had lessons or obtained licenses to start with.

And that brings us back to the Sabbath. P is here with his guitar – fortunately no amp – and appears to be practicing Sweet Child of Mine. I am hoping he will learn something new tonight.

Saturday we were invited to Henneh (Mrs Smith?) and family for "a light lunch". We arrived at their beautiful house early so decided to sit in the car until we were late. I feared the very fabric of Brazilian society would collapse if we rang their bell ahead of schedule. We sat at the pool with our light lunch of bread, cheese, olives, nuts, cookies, beers (perhaps an aperitif, sir; Whisky? Vodka? - Brazilians are very hospitable, wherever you go). It turned out (after mild gorging) that this was not lunch. We retired to the dining area for a massive salad (oddly with no sugar) which I assumed was lunch.

Then lunch arrived; a huge dish of filet mignon, roast potatoes and urinally unusually, asparagus. An unusual choice of vegetable.

Dessert was cake, a second cake, a third cake with chocolate mousse covered in chocolate and fresh fruit. I watched the cake while eating my fresh fruit. Damn you, sugar levels! Then coffee. I asked Mrs Wise Mountain what she considered a large lunch if this was light. She shrugged and said "Nu? meat and potato. How big is this?"

And that pretty much brings me back to today; the day of our departure. Phoebe is wandering around looking slightly lost as she contemplates a sudden reduction in the number of live-in victims and P has arrived but without his guitar. Strangely, I am already missing Sweet Child of Mine.

Fat Al