One in 1,000

One in one thousand.

That’s how many people die during an angiogram, according to the warning on the consent form I had to sign. This is a rather distracting thing to learn just a few moments before you undergo the procedure.

How dangerous exactly is one chance of death in a thousand? Well, it’s more than 160 times safer than Russian roulette. That sounds… good. On the other hand if one breakfast in a thousand was lethal, you’d be dead within three years. So breakfast needs to be way, way safer than that.

These are the thoughts that pass through your mind as you lie on a narrow operating table, while someone makes a hole in your wrist and slowly threads a fine tube up an artery in your arm all the way to your heart.

Now that’s quite a novel sensation. If I had to describe it in one word, the one I’d choose would be… wrong. Not painful as such, just… wrong. That is not a place where you should ever feel something moving. It was a challenge to stay calm. And yet you had no choice. If my breathing became more anxious and deep, it moved my heart too much. So I had to maintain even, shallow breaths while undergoing one of the weirdest sensations – and weirdest situations – of my life. They were injecting X-ray dye directly into my heart.

And that’s where it got really interesting.

“Of your three coronary arteries,” said the cardiologist, “two are fine. The third however is almost completely blocked, so we’re just going to pop a stent in there.”

Well, that’s quite a bit to take in at once. For a start I turn out to have heart disease, when I was still steadfast in the belief that I was having this (one chance of death in every thousand) procedure just to rule the possibility out. I was almost sure it’d turn out to be a duodenal ulcer or something. But it’s much easier to fool yourself than it is to fool medical scanning devices.

But the real headshot – they were putting a stent in now? Well I suppose it makes sense. I mean, as they’re literally here inside my heart already. Doing it again would raise the risk of death to one in 500, which clearly does not have enough zeroes after it. But… right now?

I know, when I was signing the consent form they did say something like “… and if we find a blockage we can insert a stent”. But I’m sure I didn’t hear the words “while we’re at it”. Unconsciously I’d expected some kind of consultation, with nice diagrams and maybe even counselling, before taking such a big step as having metal scaffolding inserted in my heart.

And maybe it was like that, twenty years or so ago when stents were new technology. But now they seem to be taken for granted. Hell they’re made in a factory down the road, by people I know personally. It’s all quite normal now, my head says. But my heart…

My heart was straightway overruled. It was a little painful – actually it felt exactly like one of the attacks of angina I had so easily dismissed as indigestion – but I am a cyborg now. Well, a slightly cyborg.

I’m writing this while recovering in the cardio-pulmonary ward. It’s all been very fast and a little unreal, but apparently I got here in the nick of time. If the doctor hadn’t sent me in just as soon as I described the symptoms, and if they hadn’t processed me through the system about as quickly as possible – just over 24 hours is not so shabby for heart surgery – I would almost certainly have had a heart attack. And probably sooner rather than later; that artery was 95% blocked.

But even the disease was sudden. The pain had only become a regular occurrence in the last two weeks, which is why I had put it down to gastric trouble induced by festival worries. Can heart disease really strike so fast, or were there earlier warning signs I’d missed, months or even years before? Things like the unexpected shortnesses of breath, sharp headaches after exertion, even the temporary memory loss I had two years ago?

I wonder how many of the various illnesses I’ve had in recent years were ultimately due to a heart under pressure. And in what ways I will now feel more well, thanks to a bit of metal in my chest. I look forward to finding out.

Corridors of Poor

The first thing to note is, there’s no such thing as downtime any more. Not if you can work on a mobile device. So here I am, waiting in an emergency room to be seen by cardiology for reasons that are almost certainly stress-related, and what do I find myself doing?

Actually drawing cartoons. Uploading news and pictures to the Galway Cartoon Festival page. Getting shit done.

Well it’s better than just sitting around, recovering. But in truth I can think of few things more stressful than being forced to do nothing. So this here is my compromise – blogging again. Meaningful activity, but not something I really have to do. So it feels like letting go, taking mental fresh air and exercise. We’ll see how long that lasts…

Yeah, I have taken it all a bit too far. Again. The Galway Cartoon Festival is one of the largest projects I’ve attempted in my life, and it feels like it. But on the bright side, it isn’t certain that I’ve blown my heart up. I think I’ve probably just got a bad ulcer or something. But the chest pain is ambiguous and they want to keep me in to make sure.

So what does “keeping me in” entail, a night on a trolley in a corridor?

I should be so lucky. At the moment it’s nearly 2am, and I’m still in a queue for a trolley. This is a statistic you don’t see published much – the national trolley shortfall.

As the title suggests, I am not seeing a lot of people here who look conspicuously well off. I wonder where they go when they are knocked down or have heart attacks? Perhaps here first, it can actually be very efficient – as a suspected heart patient I was was having an ECG in minutes. But I doubt they stay long.

Here where there is masking tape over cracks in the wall to keep the mold in. Where a man suffering from psoriasis asks for hours to get medication for the itching. Where a woman with epilepsy being held for “observation” has a seizure while no one is looking. These are just the things that happened right in front of me.

In the background meanwhile we have the groaning, the constant bleeping of alarms, the merry sound of vomit as the first alcohol victims arrive. And my God the coughing, everywhere. I’m here just in case I’m seriously ill. By morning I guess there will be no question.

What The Hell Happened There?

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Donald Trump wouldn’t make a convincing secretary at a half-decent country club, yet until recently he seemed a serious contender for leader of the world’s most powerful nation. That requires some explanation. It’s not credible to say that people are only beginning to realize that he’s a piece of shit. For decades he’s been famous precisely for being a piece of shit. He threatened to run for President several times before and was greeted with laughter and disbelief. Yet this time he almost went all the way, even securing the candidacy of the party which, after two Democratic terms, should have been clear favorite. What made this time so different?

Obama, naturally. Previously presidents, Republicans especially, were authority figures, high-status patrician males. And yet now the President is a black man. Which, if you’re a mindless racist, means he has lower status than you. How can you even compute that information? Either the black man can’t really be President – he must be Kenyan/Muslim/Communist/Hawaiian. Or… anyone can be.

For the first time, dumb racist losers actually believe the American legend – that they could grow up to be President. Or if not them personally, then at least that rich one from TV. Commentators have said that Trump’s followers represent the lost and disillusioned. I disagree. What we’ve learned from this election cycle is that America’s scumbags have never been more inspired and motivated.

Apple Pay?

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Apple and their ilk – remember it’s not so long since Microsoft was Ireland’s favourite taxpayer – save billions a year simply by offering to create employment here. While it would seem to make a lot of sense for a small country to buy jobs at the cost only of tax revenue that it would not have received anyway, it’s a pretty Faustian pact. For a start, what Apple is offering is not actually that great – just a few thousand jobs, and not necessarily quality, high-earning ones that feed skills into the economy. (That 200 at the new giant data center? Mostly maintenance.)

But worse, we are aiding and abetting an act which even if not illegal (as the European Commission believes), is certainly immoral. Apple is just creating artificial transactions between artificial sections of its own corporation. On paper this makes profit in Ireland; in reality of course the only transaction that has occurred was on a spreadsheet in Cupertino. The service we are offering our corporate clients is basically to act as if this is all somehow legit.

In doing so we are not merely competing with other countries. We are helping undermine the legitimate ability of countries to tax. In this race to the bottom, the only winners are the wealthy. Minister for Finance Michael Noonan claims that taxing Apple now would harm our reputation. But which reputation – the one of being a pushover for a handful of jobs? The one of being a country that sides with big business against the interests of our neighbours and of democracy itself?

Consider what harm this does to the reputation we do want: of a knowledge-based economy that pulls in investment thanks to a talented and educated workforce. There is some truth in that on the ground; people are working hard here to innovate and create businesses. But we are providing the perfect opportunity for competitors to say “That’s all bullshit, companies invest in Ireland because it’s a tax haven.”

And it isn’t easy to gainsay that view, because there’s truth in it too. The more government policy depends on low tax for foreign investment, the less we need bother with the education and infrastructure that would otherwise be the lure. (And which, we might mention in passing, would also stimulate domestic business.) The story about talent and education becomes just shtick, a hollow patter to distract from the financial shell game.

And this devalues us; not just as a place to do business, but as a country and as a people. It devalues our talent. It devalues the Masters degree I worked damned hard for. Indeed it devalues the very companies that invest here, because obviously they’re in it for short term balance-sheet gains rather than a long term investment in place and people.

Low corporation tax has been a useful tool, but that’s all it was ever meant to be – a way to help us transition from being an underdeveloped and largely agricultural economy into a diversified social democracy. The tool has now outlived its usefulness. There is no future in being the Cayman Islands of the EU.