Passing out ceremony: an Irish guard faints on St Patrick’s Day Parade, Aldershot 2012. Photo: Getty
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I thought the man had only passed out until he mentioned the severe stomach pain

Sometimes things are not as they first seem, recalls Dr Phil Whitaker about the time when a simple faint turned out to be an aneurysm. 

It was one of those glorious July days. With the sun on the canvas and the combined respiration of several hundred proud parents and grandparents, the atmosphere inside the speech-day marquee was decidedly stuffy. Faces were fanned with programmes; applauding palms were sweaty. As the procession of students collecting certificates and trophies came to an end, an elderly man in the front row slumped against the woman next to him and then keeled over on to the grass.

It took a short time to extricate myself from where I was sitting. Concerned people were huddled around the man when I got to him. For a moment, I thought there might be a full-blown resuscitation drama – he was strikingly grey and unconscious – but a swift check established that he was breathing and had a pulse.

I sent someone to call for an ambulance but within a couple of minutes the elderly man had fully come round. I took a brief history and he denied he had any symptoms suggesting that anything was seriously awry. His colour was pinking up nicely. He started to profess embarrassment at creating such a fuss. It looked like nothing more than a simple faint.

This sort of situation makes you realise how naked you are as a doctor without equipment and technology. I had nothing with which to conduct an examination or tests and the setting was far from conducive. Speech day had now finished; people were beginning to traipse out of the marquee, casting curious glances at our tableau – old man on the ground, doctor crouched in attendance – as they passed. My two children, desperate to get home and start their summer holidays, were making can-we-go-now faces at me. My patient sat up, protesting that he now felt fine. I was on the point of helping him to his feet and wishing him well when I noticed the wetness darkening his trousers.

People are occasionally incontinent when they faint but it is rare. I felt uneasy. I thought back to my first impression of him, how he had looked dead. I told him I thought he should lie back down and wait for the ambulance.

We had a minor battle of wills. His granddaughter was the head girl, he said, and this had been a big day for her; he wanted to rejoin her party. And he had the English distaste for making a scene. He almost persuaded me. When someone told me the ambulance could not negotiate the embankment down to the sports field and asked me if I really thought my patient needed it, my resolve almost faltered again – but by then I’d pushed him for more information and had elicited the grudging admission that, now I came to mention it, there had been a sudden pain in his stomach and his back before he passed out.

My suspicion was confirmed when I phoned the hospital the following day. He was in intensive care, having survived emergency surgery for a ruptured aortic aneurysm. The aorta is the body’s main artery, running from the heart down through the chest and abdomen. Its typical diameter is two centimetres. Genetic factors, high blood pressure and smoking can all weaken the aortic wall, which then distends, forming a dilatation or aneurysm. Eventually, stretched thin enough, the artery wall ruptures.

Death is rapid with a catastrophic breach but with a small minority of patients – as in this case – the initial “leak” is sealed temporarily by a clot. There follows a period during which emergency surgery to graft in an artificial artery may save life, although only half of the patients who make it to hospital survive. Aortic aneurysms predominantly affect men and become increasingly common with age. If they are diagnosed before they leak or burst, surgical repair is much more feasible, with death rates in the order of 3 per cent. Aneurysms are readily detected by a simple and inexpensive ultrasound scan and there is good data linking diameter with risk of rupture. For several years, enterprising companies have been offering scans on a private basis and in 2013 the NHS finished rolling out its own screening programme nationwide. All men are invited for a single scan when they are 65.

With a normal-calibre aorta, the risk is negligible. Aneurysms of greater than 5.5 centimetres in diameter have a high chance of rupture, so surgical repair is usually offered. Those in the “grey zone” are more difficult; the risks of surgery at a diameter of four centimetres are about equal to those of leaving things alone. Repeat surveillance scans are a way of checking for progression.

I kept in touch with the hospital over the next 11 days, at which point sadly my patient died from kidney failure caused by the blood loss he’d sustained. He had, at least, lived long enough to hear his granddaughter deliver her end-of-year speech as head girl, which must have made him proud. I learned later that she was going on to university to study medicine. I found this particularly poignant. By the time she qualifies as a doctor, the NHS screening programme should have helped reduce mortality from ruptured aortic aneurysms but it came too late for her family. The memory of that school speech day and the loss of her grandfather will no doubt stay with her throughout her career.

This article first appeared in the 03 April 2014 issue of the New Statesman, NEW COLD WAR

Photo: Getty Images/AFP
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Why is the government charging more women for selling sex but turning a blind eye to buyers?

Since 2013, the number of women charged for selling sex gone up while the number of men charged for buying it has gone down.

It’s no surprise that prostitution policy is an area rarely visited by our legislators. It’s politically charged - a place where the need to prevent exploitation seemingly clashes head on with notions of liberal freedom; where there are few simple answers, a disputed evidence base, and no votes.

There’s also little evidence to suggest that MPs are different from the rest of the population - where one-in-ten men have purchased sex. It is little wonder therefore that our report on how the law should change, published in 2014, was the first major cross-party intervention on the subject in twenty years.

Some take the view that by removing all legal constraints, it will make the inherently exploitative trade of prostitution, safer. It’s not just me that questions this approach, though I accept that - equally - there’s no consensus that my preferred measure of criminalising the purchase of sex, while decriminalising the sale, would fundamentally change the scale of the problem.

Where all sides come together, however, is in the desire to see women diverted from the law courts. It is still possible for women (and it still is women; prostitution remains highly genderised) to go to prison for offences related to prostitution. Today, in 2015.

The total number of prosecutions for all prostitution offences in England and Wales has been decreasing since 2010, but not in a uniform fashion. This does not reflect a reduction in the size of the trade, or the violent nature of it.

There were once consistently more prosecutions for kerb crawling, profiting, and control of prostitution. But since 2013, there have been more prosecutions for soliciting or loitering than for profit from prostitution and kerb crawling each year.

In simple terms, offences committed by men with choice, freedom and money in their pocket are having a blind eye turned to them, while women are being targeted - and this trend is accelerating. In the law courts, and in prosecutions, it is the most vulnerable party in the transaction, who is taking the burden of criminality.

Take on-street sex buying as an example. In 2013-14 just 237 prosecutions were brought for kerb crawling, but there were 553 - more than twice as many - for loitering and soliciting.

There is a similar pattern in the 2014/15 figures: 227 charges for kerb crawling reached court, while 456 prosecutions were initiated against those who were selling sex. Just 83 prosecutions for control of prostitution, or ‘pimping’, were brought in that same year.

These are men and women on the same street. It takes a high level of liberal delusion to be convinced that prostitution is caused by a surge of women wishing to sell sex, rather than men who wish to buy it. And yet women who sell sex are the ones being targeted in our law courts, not the men that create the demand in the first place.

This situation even goes against the Crown Prosecution Service’s (CPS) own guidance. They say:

“Prostitution is addressed as sexual exploitation within the overall CPS Violence Against Women strategy because of its gendered nature… At the same time, those who abuse and exploit those involved in prostitution should be rigorously investigated and prosecuted, and enforcement activity focused on those who create the demand for on-street sex, such as kerb crawlers.”

Why then, is this happening? For the same reason it always does - in our criminal justice system stigmatised, poor women are valued less than moneyed, professional men.

My debate in Parliament today raises these issues directly with the government ministers responsible. But to be honest, the prosecution-bias against women in the courts isn’t the problem; merely a symptom of it. This bias will only be tackled when the law reflects the inherent harm of the trade to women, rather than sending the mixed signals of today.

That’s why I welcome the work of the End Demand Alliance, composed of over 40 organisations working to end the demand that fuels sex trafficking and prostitution, advocating the adoption of the Sex Buyer Law throughout the UK.

This would criminalise paying for sex, while decriminalising its sale and providing support and exiting services for those exploited by prostitution. Regardless of these big changes in the law, I don’t see how anyone can support the current state of affairs where there are more prosecutions brought against women than men involved in prostitution.

The authorities are targeting women because they're easier to arrest and prosecute. It goes against their own guidance, common sense and natural justice.
And it needs to stop.

Gavin Shuker is MP for Luton South and chair of the All Party Group on Prostitution and the Global Sex Trade.