Anaesthesia Consent and DNR

We do  have some lovely conversations in this house…

I will, early this evening, light the metaphorical blue touch paper for tomorrows procedure. It will be ten years since I had my pT3N0M0 adenocarcinoma removed. 39 lymph nodes were extracted and pathologically examined. Since then I have had numerous colonoscopies. Tomorrow I will have general anaesthetic. I will have another endoscopy. I will be shitting my arse off, tonight and tomorrow morning.

There will be Bastille Day “fireworks” chez nous.

I have to give consent in French and nowhere am I asked if I fully understand. The assumption of comprehension is one of the clinically flawed approaches here, in my opinion. Nobody checks if you understand. It is the kind of detail which bugs me. There are a lot of assumptions in France…the process is trusted. Given the quality of healthcare it might be a good tweak to make it better.

A simple question….Do you {really} understand what I am saying?

In the unlikely event of an emergency I have said that I do not want to be resuscitated if there is a danger of paraplegia or brain death. I now have an anomaly in my ECG…

Karmically if it is time, it is time. DNR, do not resuscitate.

I am anticipating that they will find some polyps which will be excised and biopsied. If the polyps are benign my next day of joy will be scheduled five years hence. If there is a need for a follow up, I will see the chimney sweep again sooner.

This kind of thing reminds you of impermanence…

The best thing is that even with a buzz cut hair cut they make you wear a groovy hair net. I will be 24 hours with no food…having been on a white-bland no-residue diet for three days…

The diet recommendations in France speak of not eating escargot, not a problem for me. The UK ones say that you can have plain naan and chapatti…

I have manged to do a “white” curry without onion or garlic, which was passable…

Pizza is on the menu for tomorrow evening with crisps….to follow…

Bioethics, Genetic Testing and Notification

This morning, just for a change, we went to another hospital for a genetics follow up to the wife’s breast cancer. In France they are very keen on prophylactic measures and like to test things in a lab wherever possible. The wife’s blood is going to be screened for genetic predisposition to breast and ovarian cancer. The results will have implications for her and her siblings, including the men. In French law the geneticist or the wife herself MUST inform her brother if the tests suggest that he too might have a predisposition for cancer. This true for if he lived in France not sure if it extends legally to the UK. The form letter on the government site, for the geneticist to fill in, does not really hide the identity of the provider of genetic material very well. Today she advised against sending this. It was better to pass on the tidings of joy personally.


« Décret n° 2013-527 du 20 juin 2013 relatif aux conditions de mise en œuvre de l’information de la parentèle dans le cadre d’un examen des caractéristiques génétiques à finalité médicale.

Notice : la loi no 2011-814 du 7 juillet 2011 relative à la bioéthique a modifié le dispositif d’information de la parentèle dans le cadre d’un examen des caractéristiques génétiques introduit par la loi no 2004-800 du 6 août 2004 relative à la bioéthique. La personne concernée est informée, avant la réalisation de l’examen de ses caractéristiques génétiques, de l’obligation qui pèse sur elle, au cas où une anomalie génétique grave serait diagnostiquée, d’informer les membres de sa famille potentiellement concernés dès lors que des mesures de prévention ou de soins peuvent leur être proposées. »


The gastroenterologist following my colon cancer has been very pushy about me notifying blood relatives because there is some genetic component to colon cancer.

I have already tested for HBA B27 which was negative therefore there are no requirements for notification. There are no possible interventions foreseen.

I am considering HFE and JAK poly screening, the latter of which costs ~€1500. The HFE if positive would indicate hereditary Haemochromatosis which can have interventions. The JAK poly screening for predisposition to malignancies, would if positive, require notification. There would under law be an obligation to inform.

This explains why the GP isn’t overly keen. There is a possible can of worms attached.

The documentation for the test today has inherent in it an authorisation to share genetic test results with relatives if relevant to their healthcare.

Given the price of the test, I am likely to need a specialist to write the JAK screening prescription. They may well want a “who do you think you are” family tree.

You learn something every day…and given the French love of protocol this is non-negotiable.

There are often implications we do not consider…and only find subsequently.

Once you have had test results you cannot un-have them or un-see them…

Hmnn…

Leaving the Palace and Miscellaneous

Nirmāṇakāya (Chinese: 應身; pinyin: yīngshēn; Tibetan: སྤྲུལ་སྐུ་, tulku, Wylie: sprul sku) is the third aspect of the trikāya and the physical manifestation of a Buddha in time and space.

Nearly ten years ago I tried to explain to the anaesthetist that because of the very large amount of meditation I had done there might be some anomalies in how I responded to medication – anaesthetic. They completely ignored me and did not take me in any way seriously. A few days subsequent to the operation I had strong recall of being above the operating table watching the “vultures” around my corpse operating. On going into theatre, I was chatting about the clean room conditions of the operating theatre. The same night after ~ six hours of surgery to remove a colon cancer, I stood on my own two feet. Which freaked out the nurse in recovery.

I am pretty sure that something weird transpired during the operation and that it was not spoken about.

There is no way that a modern medical professional would countenance the notion of a nirmāṇakāya or janmanirmāṇakāya; སྐྱེ་བ་སྤྲུལ་སྐུ, skye ba sprul sku. Nor that they might be biologically different to a regular human being.

If one takes the dreaming “evidence” in this blog, then there is a hint of non-standard reincarnations plural stemming back lifetimes. It could be a Soul reincarnating or it could simply be some kind of emanation. In the latter case the emanation body or nirmāṇakāya may not clothe itself in meat in a standard way. I have not read of any different approach to the medical treatment of Tibetan tulkus. But there is a vast amount of stuff which is kept away from prying eyes. My guess is that Tibetan Vajrayana etc. is like an iceberg, with only a tiny bit showing.

The body may be similar but the “mind” very different. Tulkus may be very different to normal people though looking the same. The manifestation, the emanation, need not be that of a full buddha.

On the horizon for me are up to three more major surgeries. In 2019 they put my titanium pin into the left femoral neck/head whist under the influence of a spinal injection and some other drugs. I can remember the bone shaking pneumatic drill. They would not let me watch even though I asked. It was enough to induce PTSD…I was conscious if drugged.

It can be said or observed that I left / renounced the Imperial palace, when I walked out of my job as a senior lecturer at Imperial College in London. I was a strict vegan for a long time, close to nine years. I walked out of a relationship with a wife, a home and a very young female child. I renounced my family later. I meditated extensively away from the madding crowd. I learned science sport and martial arts. There are some of the twelve acts attributed to Siddartha.

At a very long stretch one could say I share these, have them in common.

There is a part of me that wonders if the medical approach to me needs to take other factors into consideration. This adds a little reticence to the notion of drastic orthopaedic surgery. Somehow, I need to understand better…

Hmmn..

Blundering About – Backstory and Context

In the academic year 2014-15 I did some science tutorials in Chemistry and Physics. Most of these were 1:1 AS and A2 tutorials. Given that I had a colectomy for a T3N0M0 tumour on 2nd July 2015 I was going through the two week referral processes together with sigmoidoscopies, biopsy and two colonoscopies during the exam run-in and exam period. The biopsy came back negative but on the basis of imagery they went for the knife.

In order to manage this, I was mega-organised and prepared for each tutorial. I had to cut some work pieces out and be more selective in choice. Hopefully nobody noticed I was ill / stressed and my efforts were of their usual impeccable standard. I had a backstory and a context which no one knew. I did not want to have hand wringing, victim minded, people around me and was perhaps terse with them. I may have been short with others. My main focus was to ensure that the operation happened as fast as possible. I applied some pressure.

In academic year 2015-16 I once again did tutorials. In two family houses the atmosphere was palpably tense. The mother in one said that she was being treated for breast cancer. I said snap, me too. The ice was broken, everyone relaxed. In the other it was kept secret until the chemo made it more obvious. The lad was tense and when he finally spilled the beans, I was able to assist him on other levels than science.

 In some cases, bringing the backstory to the fore makes things a whole lot easier.

Human beings tend to blunder about like bulls on amphetamines in china shops. Even the so-called intelligent can be very blinkered and myopic. The self-diagnosed omniscient have perhaps the greatest lack of sensitivity and situational awareness.

I have for example been having a “discussion” with someone. They have been professing and proclaiming from their soap box, letting fall their precious pearls of wisdom for my benefit. Whilst I have been looking at the bridge of their nose and debating quietly to my self if I should headbutt them to make them shut up. My assessment is/was that they were unaware of how close they were to peril. Enamoured by the sound of their own voice they were blundering about.

People can assume shared context when none exists. Without participating in self-percussion, it is likely that my background context and experience here differs markedly from the locals. There is no way that I can make them aware of the implications of that context. Yet from time to time is does manifest, often to their surprise. I doubt anyone I have met here has been offered a job at the European Space Agency or negotiated at ASML headquarters. That kind of thing changes you a bit.

Context is important it changes how we perceive things markedly.

I now have a working hypothesis. Everyone who is a British expatriate here has a backstory of some kind which differs from the UK white picket fence and 2.2 children norm. How it differs I don’t know. There is a need for resourcefulness in a place where the willingness to speak English is low. People find ways.

There is no easy way to make people aware of some aspects of backstory or context. Contact can be too fleeting to warrant it. But this lack of awareness that such a thing might exist can cause problems. Being self-centred like a medieval pope, people imagine that the world revolves around them, to say otherwise if heresy and heresy has high often flammable stakes.

The problem with blundering about on a mission, lacking sensitivity is that you can make some truly whoppers of faux pas. It can be very difficult to extract from the socio-political embarrassment. Losing face is not an option so the awkwardness must pervade and maybe fade. People find it really hard to admit that they fucked up. This lack of social adroitness is another form of blundering about.

“I don’t have to apologise for the BYOB parties at Downing Street…”

Is an example of someone unwilling to accept responsibility for their actions.

If you have a backstory then it stands to reason others do too. Perhaps we need to be a little more sensitive about context and implications.

On the other hand, you could slash overseas aid to appease a domestic audience and allow hundreds of thousands {foreigners} to die because you have pulled the carpet out from under their feet. They do not matter after all.

People blundering about can have marked long terms impacts on and in the lives of others…

Asking the Right Questions – CT Scans

One of the things raised by the spine surgeon was the need to have comparable CT scans over time. I remembered that I had a benchmark post cancer op CT scan not long after we arrived in France. Incidentally this time a decade ago, 2015, I was collecting “blood in poo” data whilst in Malta prior to kicking off the colon cancer investigation.

I have been unable to get the imagery service to remount the full data {yet}, but like a squirrel storing nuts I have images.

Sometimes thinking differently to others does not go down well. Questioning is not always welcome.

” I told you I was ill”

I have fished the images out. The radiological report was focussed only on the possible recurrence and metastases of cancer. The scan was reported as normal.

Close examination reveals some spinal anomalies in 2020 which suggest “bone” growth has been going on for five years.

One can see a “bony” anomaly to the image left hand side of the thoracic spine. The aorta, round circular grey thing, is not yet displaced significantly to the right in the image. This image is a mirror, right in the image is left in my body frame.

Looking down at the pelvis area we have.

To my untrained eye there is spinal torsion towards the image left, corporeal right. The sacroiliac joints are asymmetric.

The final image looks distinctly unbalanced and odd. It does not sit well with my need for symmetry and although it could be an artefact, it is a pretty big one. This “deformity” if it is one could explain much…

A year prior to this I had a titanium “nail” inserted into my left femoral neck/head to repair a facture.

I had to wait three days to be operated on. Not much was said to me about the whole thing.

In principle then I now have before and after CT scans to demonstrate the growth of whatever it is on my spine…

The radiologist answered all the questions asked of them but did not comment on the spinal column, which seems bit odd to me. But I do not know what common clinical practice is. One could talk about CT images ad infinitum. There needs to be some focus.

Not sure what if anything to do with this…

Questioning Deity – Are You Autistic?

Not long after I had my colon cancer operated on; I contacted a specialist in adult autism. I wanted to find out if I was autistic or had Asperger’s, albeit high functioning. The other day we watched Claire Taylor in a documentary called “Are You Autistic?” In that documentary a few people diagnosed with autism spoke of the phenomenon of “masking” in which they behaved in a manner so as to conceal their underlying autism. Said masking is tyring and can lead to burn out.  

I have a similar notion which is called chameleon. I can blend in, mimic and fit in for a while. I can be at home in a posh place like the Ritz or the Hotel New Otani in Tokyo. I can also go into a very rough dive / criminal pub and have a beer without fear.

One of the motivators behind my inquiry is/was the over-reaction to question and critique which I have experienced from the self diagnosed omniscient, pompous and self-important people over the years. Those equipped at birth with a penis are the worst at this over-reaction.

Maybe they are just deeply insecure?

Maybe I have autism?

Maybe I simply fail to kowtow to socio-political order and the pecking-order held in mind?

The specialist concerned, being a psychologist, wanted to know if my inquiry was about the cancer and dying. {See people make assumptions all the time!!} Because, I did not have enough witnesses about my pan-continental childhood and any extant parents, she was unable to complete the full diagnosis. She offered her opinion based on our conversation that I was not autistic. You could say it is/was moot. Either I am not autistic or I am damn good at masking. Place your bets.

It seems to me I keep coming across, mostly men, who react badly to me even if I am not challenging them. I could be delusional. There are a large number of observations where I don’t talk enough bullshit, pat backs and otherwise ritually sniff arseholes. Some how I am not laddie enough. It is so false and such a waste of time.

I have a hunch that I/we are in the fallout stage of one of these interactions. Face is very important so not a lot can be done.

One is not allowed to question deity and masculine medical deity in particular. It gets their hackles up.

Hey-ho…

I have started looking into alternative arrangements now…

Dual Colonoscopy Dream 21-12-2024

This is, for me, one of the weirdest dreams I have had, because it is so matter of fact and “normal”. The last time I had a medical themed “dream” was when I recalled seeing my laparoscopic colectomy from above. They were removing my T3 colon cancer. I was in theatre for around six hours and had an OBE. I speculated that I died briefly on the table. The after care in recovery for me seemed much more attentive than that for the others in the room. Before the dream I had a very strong visual / connection with someone I knew about 20 years ago whose surname is Colon.

The dream opens with me on an operating type of bed. I have a blue medical gown on with a hairnet. My knees are up towards my stomach and the gown is open at the back. I am lying on my right side and viewing a computer screen which shows my colon from the point of view of a colonoscope operator. They are withdrawing the instrument because this first attempt at a full colonoscopy has failed. They have decided to try a different instrument. The instrument is withdrawn. I observe this.

A nurse comes around to speak to my face. She tells me what is going on. She administers some sedative via the catheter in my arm. She tells me that they are going to give me a brief general anaesthetic. The doctor inserts the colonoscope and I can see it moving into the sigmoid colon and up towards the splenic flexure. The colon looks free of polyps and cancer. As he approaches the splenic flexure the nurse administers the general anaesthetic. I know from before that passing the flexure is the most uncomfortable part. I wait a few seconds. Then in the dream I can feel the anaesthesia come up and I become unconscious in the dream.

I wake up in the recovery room. In the dream I am puzzled as to why I am having this life like vivid experience of colonoscopy.

The dream ends.

On waking I make a note that maybe I should arrange to have my next colonoscopy early in the new year.

A New Phase?

My previous passport was set to expire in March 2015 so I applied for a new one in September 2014. The following year I joined the big C club and was operated on 2nd July at full moon. The cancer was diagnosed pT3N0M0 with around 40 clear lymph nodes. They caught it just in time as at T3 it had broken through the colon wall. That passport kicked off a new phase of my life. I had colon cancer and bought myself T-shirts with a large semicolon on. I no longer had a full colon. I did not get any chemotherapy. I was now very expensive to insure in terms of life cover. Key man insurance was in the 50 grand sterling range. I did not want to continue tutoring high school science.

I have just applied for a new passport. The passport office have told me that it is printed and on its way. A passport is an identity document. My identity has been renewed. I hope this one is not a harbinger of doom. We have seen too many hospitals these last few years.

I have had a feeling these last few weeks that I am waiting for something and that something new is on its way.

Suddenly two things went our way. I caught the stray Tom and he is back now neutered looking at me through the window to see if there are any more bits of food. The vet thinks he may have feline FIV. And the volet company can fix our volets before Christmas!!

I am a bit sad in that my new passport will not be an EU one…

It is a full moon today…

Hmnn