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

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The World Cup you’ve never heard of, where the teams have no state

At the Conifa world cup – this year hosted by the Autonomous Republic of Abkhazia – ethnic groups, diaspora communities and disputed territories will battle for footballing glory.

Football's European Championship and the Olympics are set to dominate the back pages over the next few months. How will Team GB fare in Rio? Will the zika virus stop the tournament even going ahead? Will the WAGS prove to be a distraction for the Three Lions? And can Roy Hodgson guide England to a long-awaited trophy?

But before the sprinters are in their blocks or a ball has been kicked, there's a world cup taking place.

Only this world cup is, well, a bit different. There's no Brazil, no damaged metatarsals to speak of, and no Germany to break hearts in a penalty shootout.  There’s been no sign of football’s rotten underbelly rearing its head at this world cup either. No murmurs of the ugly corruption which has plagued Fifa in recent years. Nor any suggestion that handbags have been exchanged for hosting rights.

This biennial, unsung world cup is not being overseen by Fifa however, but rather by Conifa (Confederation of Independent Football Associations), the governing body for those nations discredited by Fifa. Among its member nations are ethnic groups, diaspora communities or disputed territories with varying degrees of autonomy. Due to their contested status, many of the nations are unable to gain recognition from Fifa. As a consequence they cannot compete in tournaments sanctioned by the best-known footballing governing body, and that’s where Conifa provides a raison d’être.

“We give a voice to the unheard”, says Conifa’s General Secretary, Sascha Düerkop, whose world cup kicks off in the Autonomous Republic of Abkhazia at the end of this week.

“We are proud to give our members a forum where they can put themselves on the map.

“From that we hope to give back in the long run and invest in the football infrastructure in our member nations to help them grow.”

The two week footballing celebration starts with an opening ceremony before Kurdistan and Székely Land kick off the tournament. It follows on from 2014’s maiden competition which saw The County of Nice avenging a group stage defeat to Ellan Vannin from the Isle of Man, to take the spoils in the final via a penalty shoot-out.  There were some blowout scores of note however, with South Ossetia smashing Darfur 20-0 and Kurdistan beating the Tamils 9-0 at the event which took place in Östersund, Sweden. Neither of the finalists will be returning to the tournament – throwing down the gauntlet to another twelve teams. 

This, the second Conifa world cup, is testament to the ever-expanding global footprint of the tournament. Abkhazia will welcome sides from four continents – including Western Armenia, the Chagos Islands, United Koreans in Japan and Somaliland.

Despite the “minor” status of the countries taking part, a smattering of professional talent lends credibility to the event. Panjab can call on the experience of ex-Accrington Stanley man Rikki Bains at the heart of their defence, and the coaching savoir-faire of former Tranmere star Reuben Hazell from the dugout. Morten Gamst Pedersen, who turned out for Blackburn Rovers over 300 times and was once a Norwegian international, will lead the Sapmi people. The hosts complete the list of teams to aiming to get their hands on silverware along with Padania, Northern Cyprus, and Raetia.

A quick glance down said list, and it’s hard to ignore the fact that most of the nations competing have strong political associations – be that through war, genocide, displacement or discrimination. The Chagos Islands is one such example. An archipelago in the Indian Ocean, Chagos’ indigenous population was uprooted by the British government in the 1960s to make way for one of the United States' most strategically important military bases – Diego Garcia.

Ever since, they've been campaigning for the right to return. Their side, based in Crawley, has crowdfunded the trip to the tournament. Yet most of its members have never stepped foot on the islands they call home, and which they will now represent. Kurdistan’s efforts to establish an independent state have been well-highlighted, even more so given the last few years of conflict in the Middle East. The hosts too, broke away from Georgia in the 1990s and depend on the financial clout of Russia to prop up their government.

Despite that, Düerkop insists that the event is one which focuses on action on the pitch rather than off it. 

“Many of the nations are politically interested, but we are non-political,” he says. 

“Some of our members are less well-known in the modern world. They have been forgotten, excluded from the global community or simply are ‘unpopular’ for their political positions.

“We are humanitarians and the sides play football to show their existence – nothing more, nothing less.”

The unknown and almost novel status of the tournament flatters to deceive as Conifa’s world cup boasts a broadcast deal, two large stadiums and a plush opening ceremony. Its aim in the long run, however, is to develop into a global competition, and one which is content to sit below Fifa.

“We are happy to be the second biggest football organisation,” admits Düerkop.

“In the future we hope to have women’s and youth tournaments as well as futsal and beach soccer.”

“Our aim is to advertise the beauty and uniqueness of each nation.”

“But the most important purpose is to give those nations that are not members of the global football community a home.”

George Weah, the first African winner of Fifa World Player of the Year award remarked how “football gives a suffering people joy”.

And after speaking to Düerkop there’s certainly a feeling that for those on the game’s periphery, Conifa’s world cup has an allure which offers a shared sense of belonging.

It certainly seems light years away from the glitz and glamour of WAGs and corruption scandals. And that's because it is.

But maybe in a small way, this little-known tournament might restore some of beauty lost by the once “beautiful game”.