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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On civil liberties, David Davis has become a complete hypocrite – and I'm not sure he even knows it

The Brexit minster's stance shows a man not overly burdened with self-awareness.

In 2005, David Davis ran for the Tory leadership. He was widely assumed to be the front-runner and, as frontrunners in Tory leadership campaigns have done so enthusiastically throughout modern history, he lost.

The reason I bring up this ancient history is because it gives me an excuse to remind you of this spectacularly ill-judged photoshoot:


“And you're sure this doesn't make me look a bit sexist?”
Image: Getty

Obviously it’s distressing to learn that, as recently as October 2005, an ostensibly serious politician could have thought that drawing attention to someone else’s boobs was a viable electoral strategy. (Going, one assumes, for that all important teenage boy vote.)

But what really strikes me about that photo is quite how pleased with himself Davis looks. Not only is he not thinking to himself, “Is it possible that this whole thing was a bad idea?” You get the distinct impression that he’s never had that thought in his life.

This impression is not dispelled by the interview he gave to the Telegraph‘s Alice Thompson and Rachel Sylvester three months earlier. (Hat tip to Tom Hamilton for bringing it to my attention.) It’s an amazing piece of work – I’ve read it twice, and I’m still not sure if the interviewers are in on the joke – so worth reading in its entirety. But to give you a flavour, here are some highlights:

He has a climbing wall in his barn and an ice-axe leaning against his desk. Next to a drinks tray in his office there is a picture of him jumping out of a helicopter. Although his nose has been broken five times, he still somehow manages to look debonair. (...)

To an aide, he shouts: “Call X - he’ll be at MI5,” then tells us: “You didn’t hear that. I know lots of spooks.” (...)

At 56, he comes – as he puts it – from “an older generation”. He did not change nappies, opting instead to teach his children to ski and scuba-dive to make them brave. (...)

“I make all the important decisions about World War Three, she makes the unimportant ones about where we’re going to live.”

And my personal favourite:

When he was demoted by IDS, he hit back, saying darkly: “If you’re hunting big game, you must make sure you kill with the first shot.”

All this, I think, tells us two things. One is that David Davis is not a man who is overly burdened with self-doubt. The other is that he probably should be once in a while, because bloody hell, he looks ridiculous, and it’s clear no one around him has the heart to tell him.

Which brings us to this week’s mess. On Monday, we learned that those EU citizens who choose to remain in Britain will need to apply for a listing on a new – this is in no way creepy – “settled status” register. The proposals, as reported the Guardian, “could entail an identity card backed up by entry on a Home Office central database or register”. As Brexit secretary, David Davis is the man tasked with negotiating and delivering this exciting new list of the foreign.

This is odd, because Davis has historically been a resolute opponent of this sort of nonsense. Back in June 2008, he resigned from the Tory front bench and forced a by-election in his Haltemprice & Howden constituency, in protest against the Labour government’s creeping authoritarianism.

Three months later, when Labour was pushing ID cards of its own, he warned that the party was creating a database state. Here’s the killer quote:

“It is typical of this government to kickstart their misguided and intrusive ID scheme with students and foreigners – those who have no choice but to accept the cards – and it marks the start of the introduction of compulsory ID cards for all by stealth.”

The David Davis of 2017 better hope that the David Davis of 2008 doesn’t find out what he’s up to, otherwise he’s really for it.

The Brexit secretary has denied, of course, that the government’s plan this week has anything in common with the Labour version he so despised. “It’s not an ID card,” he told the Commons. “What we are talking about here is documentation to prove you have got a right to a job, a right to residence, the rest of it.” To put it another way, this new scheme involves neither an ID card nor the rise of a database state. It’s simply a card, which proves your identity, as registered on a database. Maintained by the state.

Does he realise what he’s doing? Does the man who once quit the front bench to defend the principle of civil liberties not see that he’s now become what he hates the most? That if he continues with this policy – a seemingly inevitable result of the Brexit for which he so enthusiastically campaigned – then he’ll go down in history not as a campaigner for civil liberties, but as a bloody hypocrite?

I doubt he does, somehow. Remember that photoshoot; remember the interview. With any other politician, I’d assume a certain degree of inner turmoil must be underway. But Davis does not strike me as one who is overly prone to that, either.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.

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