Thick Skin and the Colour of Pain

A Familiar Ethnicity Pain Gap

It comes as no surprise to me to read that in the UK, women from Bangladeshi, Pakistani, and black Caribbean backgrounds were less likely than white women to receive an epidural whilst having a vaginal birth. [The Guardian: “Women from minority backgrounds in UK less likely to receive epidurals, research finds”]

The ideas, conceptions, perceptions, or prejudices that feed the narrative that non-white people, especially from the aforementioned backgrounds, do not need adequate pain medication to arrest high levels of discomfort and distress have appeared in studies for decades.

This situation, termed the "ethnicity pain gap", is quite concerning, and it might persuade one to surmise that there is a seething racialised disadvantage in the public health system, one that ascribes thick skin to the Black population and precious delicateness to the Asian cohort.

My Own Experience

My experience of this in late 2009 came as a result of cancer pain in its enduring intensity. I was on multiple regimens of pain medication, with Fentanyl dispensed as a transdermal patch being the most critical palliative, yet I was in pain.

When I informed my consultant that I was still in pain, and this was in the Netherlands rather than in the United Kingdom, he did not acknowledge my distress or seek to address it. Instead, his response was that the pain medication I was on should be enough. An ill-informed perception that I should have a higher pain threshold.

I remonstrated that it was not, and he then sought to double the dose from 12.5 micrograms to 25 micrograms. This made all the difference because it tackled the pain, and I got much-needed relief. Why I was not also told that transdermal patches could fall off, and that they could be held in place on the skin with an adhesive film, escapes me.

Knowledge Withheld

Returning from church, one Sunday, a few weeks after I had the new prescription, I was in a lot more pain than usual, and then I saw that the patch had fallen off.

I laughed myself to delirium to produce endorphins as pain relief whilst the new patch took hold. It was only when I told the nurse who came to dress the lesions on my foot daily that he told me I could get an adhesive film to keep the patch in place.

The knowledge was there all along, but it was never shared. As a race, in our encounters with the medical establishment, we are constantly pathologised, and this is characterised by either not being listened to or being ignored, because the medical personnel assume they know and understand our bodies more than we do with the intimate experience of our own skins.

Asserting Our Reality

That Caucasians are immediately responded to and given palliative succour on demand speaks volumes, without suggesting something untoward. Whether it is bias, prejudice, or indifference, we need to be better equipped to ask pertinent questions and persuade our doctors of our reality, without having to jump through hoops, trapped in suffering until it becomes unbearable.

It is not just in matters of pain, but in decisions being made about diagnostic and treatment regimes without explanation or rationale, delay in action when the full knowledge of a condition is evident, the lack of respect, courtesy, and the according of dignity to your personhood and humanity, or the use of the wrong indicators based on race for decision trees towards useful outcomes.

I approach the medical establishment on the premise of “It is my body first, before it is your guinea pig.” This need never be the default, because you are then preparing for a fight instead of fully trusting someone who took the Hippocratic Oath to do you no harm. Yet you find you need to assert yourself and manage the egos to ensure that you, at the very least, leave the hospital better than when you went in.

A Google NotebookLM AI Podcast on this blog

From Compote to Coulis

The Value of Cooking

Being able to cook, or at least understanding the processes of cooking, not only informs you about quality and taste, but it also helps you appreciate the kind of labour involved in bringing a dish to the table.

Sometimes, we allow convenience to trump the need to slave over a cooker or an oven, or, in these times, a crockpot or slow cooker, a steamer, and an air fryer. Well, a rice cooker has now joined the appliances in my cramped kitchen. Utility meets facility, and the rest is the memory of the palatable.

Convenience Versus Craft

Supermarkets tend to offer convenience at the expense of kitchen activity; the onions come ready-chopped in a pack when I could use a mandolin and store them in a Ziplock bag in the freezer. When I could not get Agege bread in Cape Town, I began to bake my own; now that it is sold here, I simply buy it in the shops.

One time, whilst mixing the dough, one of the mixing hooks broke. It should have been an easy replacement, but by then the novelty of baking had worn off.

I can make most of what I like; it is the lack of time, patience, or will that militates against the creative process, so you reach instead for the processed food shortcuts in supermarket packs or obtain takeaways from restaurants.

Experiments with Yoghurt

For a while, I stopped buying yoghurt with fruit servings. Instead, I would get Greek yoghurt and add it to a fruit salad drizzled with honey, but I wanted something different. I made a compote of blueberries and raspberries, cooking the fruits with a little water and lemon juice, though I did not have any vanilla essence.

I liked the first result with Greek yoghurt and honey, but I left the compote too long in the fridge and it was developing a culture, so I had to throw it away. I soon made another portion, which I never used. I warmed it up in the microwave and it bubbled out of the container, filling the microwave plate with red juice. That was annoying to clean up.

From Compote to Coulis

When I went out shopping yesterday, I bought a pack of wonky raspberries and one of blueberries. Something about the chunky feel of the compote did not appeal to me, so this time, after cooking the fruits and mashing them in the pot, I decided to try something else. What about blending the compote, I thought?

Well, that changes a compote into a coulis. I did not pass the blended compote through a sieve, but I think the NutriBullet blender did a good enough job, and this time I added some Madagascan vanilla essence. I might also add a splash of brandy to give it longevity, which is what you would expect in a compote rather than a coulis.

The knowledge of cookery does not just give you the ability to follow a recipe, even though much of one's expertise comes from learning, experience, practice, and memory. The recipe, like rules, can be broken to suit your own requirements and taste, and you would be neither persecuted nor prosecuted for it. That, my friends, is the joy of knowing how to cook.

A Google NotebookLM AI Podcast on this blog

Thought Picnic: Meeting Your Estranged Children Where They Are

Adapting to a Changing World

I am constantly told that I need to make allowances for the older generation because they are set in their ways. This might be true, but the world is always changing around us, and thriving in any community requires steady, sometimes sudden, adaptations if we are to relate to people, events, ideas, and circumstances.

Whilst reading an article on LinkedIn titled “Meeting Your Resistant Children Where They Are”, I immediately realised that it seemed to address only one part of the wider issue of relationships. The article focused more on divorced parents and their apparently adolescent children, and I appreciate that the writer's area of expertise is divorce and parenting.

If I were to extrapolate, however, the issue extends well beyond divorce, which is merely one of the elements contributing to the breakdown of relationships, just as resistance is only one facet of parent-child estrangement.

The Generational Cycle

It is interesting to observe how we all move through the generational phases of life, beginning as children with parents, grandparents, and great-grandparents, and then transitioning through these phases as those who came before us begin to drop off, in that natural cycle of life.

How we relate to those before us sometimes follows an established code of community, reverence, and respect. What rarely finds adequate scrutiny is the need to adapt for those who come after us.

For instance, when does a parent begin to see their child as an adult, one to be treated with some acknowledgement and, I dare say, respect for their autonomy, independence, initiative, and decision-making?

A Personal Reflection

Then again, this topic is probably too broad to be addressed in a blog, or from an amateur's background, even with the lived experience that might cloud one's judgement. My parents were never divorced; rather, with the palpable tension, the middle-aged theatrics, and the passage of time, they grew apart.

It might have been better had they gone their separate ways a long time ago, rather than being hemmed in by middle-class values until their cohabitation became untenable. Each kept their own record of what the other might or might not have done, and we, the children, were corralled into narratives that expected us to take sides; in the main, we tended to remain neutral.

However, to bring this conversation back on course, there is where my parents expect me to be, where they see me, and where I actually am. These are entirely different places. Whether I am a child, an adult, pliant, or recalcitrant, I can only wonder whether I am all of these at the same time. The fact that I have never been a parent might inform other perspectives.

Naming the Thing

Still, there is a name for the thing I am circling, and I only came upon it recently: relational maturity. It is not the same as being agreeable, nor the same as being patient, though it borrows freely from both. It is, rather, the capacity to meet another person where they actually stand, without insisting they first travel to where we happen to be waiting for them. I had felt its absence for a lifetime without ever knowing what to call it.

The question that follows is not a comfortable one: who is obliged to do the adjusting? Tradition has a ready answer, that the younger defers to the older and the child to the parent, and like most tidy arrangements, it survives chiefly because it serves the people who designed it.

Relational maturity refuses this one-way traffic. It accepts that adjustment must flow in both directions, that the parent who demands reverence might first ask whether they have offered acknowledgement. I say this as a sexagenarian, mind you, and not as a young firebrand with a grievance, for I am now of the very generation that is customarily granted the latitude I am here declining to claim.

There is a temptation to mistake all this for weakness, as though meeting people where they are were merely a polite word for capitulation. It is nothing of the sort. The mature party is not the one who folds; it is the one who can hold their own position firmly whilst still granting the other their dignity and their difference. Anyone can be tolerant of those who already agree with them; the test arrives with the person who does not.

And yet relational maturity is not infinite. There comes a point where meeting someone where they are reveals only that they have no intention of moving, and no interest in your moving either. At that juncture, the mature response is not to keep travelling toward a meeting that will never take place, but to disengage calmly and without rancour, which is itself a form of maturity.

Snipping the Cord

Certain interactions have rubbed me up the wrong way, and my reaction has usually been to disengage. People, and this goes beyond parents to siblings, relations, friends, and others you encounter throughout life, seem to forget that, regardless of what they assume ties you together, you can snip the cord and walk away, unbound, unfettered, and unconcerned.

The way you address and talk to people, their slight and unfortunate expressions of indifference, and the use of words that fail to give credence to the multifaceted nature of a person, or that fail to acknowledge the changes we see in ourselves and in others, can alter things so radically as to put them beyond redemption.

Tradition Versus Individuality

Tradition might dictate one thing, but personalities are individual and unique; they may not conform to any prescribed norms and may fall entirely outside our common frames of reference.

The question, then, becomes whether you are ready to shift your position, find common ground, seek resolution, and even accept that you were wrong, despite your ways being set in reinforced concrete.

The Cost of Indifference

I remember conversations and interactions that informed my decision to withdraw fellowship from certain people. You may not realise you have done something wrong, albeit inadvertently, but whoever is doing the kicking is rarely the one doing the hurting.

There might be another way to work through this, yet I am only human, and there is a dignity in that which demands the courtesy of others, regardless of the ties.

Restrict this ever-constant need to adapt our relationships, the need that keeps conversation thriving and engaged, all in the name of conserving what we think we hold dear, and the consequences will be exactly where we find ourselves, whether we are involved or not.

Honour and Provocation

Parents tend to think of estranged children as personifications of the Prodigal Son. Yet we, the children, eventually begin to see our parents with all their flaws, and for all the care and responsibility that went into their parenting, they were never in the class of God; they were simply human. Where the holy book says, “honour your father and mother”, it also says, “do not provoke your children unto wrath”.

Someone really ought to write an academic study on “Meeting Your Estranged Children Where They Are”.

A Google NotebookLM AI Podcast on this blog

The Brexit Decade

Another chair short in the Number 10 musical chairs farce.

A Decade of Self-Harm

Even irony has come to joke at the expense of the United Kingdom. On the eve of the 10^th anniversary of the Brexit vote, the sixth prime minister since that act of unmitigated self-harm resigned.

Whether you like it or not, Brexit made the UK ungovernable, and it is the spectre of Brexit that has deftly conducted the dirge of musical chairs at 10 Downing Street.

Obviously, the personification of this rotten enterprise is Nigel Farage, along with all the cloaks of calumnious obfuscation he has donned aboard the various political vehicles he has ridden to beguile the natives.

Cameron's Fatal Gamble

In trying to outmanoeuvre and upstage Farage, David Cameron promised an in-out referendum without thresholds, believing he could gamble with our future in Europe and win. He lost. Once the result was announced, he resigned.

The chicanery between Michael Gove and Boris Johnson, who were the opportunistic ruling party figureheads of the Brexit proposition, meant that Theresa May, a remainer, became prime minister.

Everything she tried to negotiate with Europe was rubbished and undermined by the antics of Boris Johnson and a cohort of implacables. First, Theresa May gambled away her majority, and every Brexit negotiation ended in stalemate. She resigned within three years.

Johnson Gets Brexit Done

Boris Johnson then took the helm and purged the Tory Party of the reasonable, level-headed and moderate One Nation Tories, before calling an election to "Get Brexit Done".

The least qualified person ever to negotiate a deal, having had a background in the Scottish whisky industry, became the point man: Lord David Frost. What he brought back was a mishmash of imponderables, and we signed ourselves out of prosperity just as the coronavirus took hold of the world.

Boris made stringent rules for us, with punitive fines for breaking them, yet he and his staff were partying in Downing Street. That scandal, along with a few others, engulfed his premiership and culminated in the resignation of more than half his cabinet. It soon dawned on him that he had to go. He held office for three years.

Truss and the Lettuce

Enter Liz Truss, who, after kissing hands at Balmoral, may well have hastened the demise of Queen Elizabeth II two days later. Her curtsey was so awkward that you couldn't tell if she was flat-footed, bow-legged, or suffering from some yet unexplained ailment of her lower ambulatory system. Rather than laugh, you pitied her.

Her uncosted mini-budget, aiming to introduce us as the new Singapore on Thames, one of the sunlit uplands of Brexit, much as Canaan was given to the Jews, wreaked havoc on the financial markets.

The fallout was so drastic that she sacked her Chancellor of the Exchequer and brought in a Tory grandee of a sort, Jeremy Hunt. The sand was running out of her hourglass; days became minutes, and even a patch of lettuce outlasted her. She was gone in 50 days.

Sunak Steadies the Ship

Rishi Sunak, the first Asian, the first Hindu, and possibly the richest ever prime minister, walked into 10 Downing Street. He steadied the ship that had been caught in various post-Covid, Brexit and immigration eddies. We were in a spiral, and it was only a matter of time before we lost our heads in a dizzy spell.

He called an election about twenty months into his premiership and handed the reins over to the Labour Party in a landslide, after the party had been out of power for 14 years.

Starmer's Short Tenure

Sir Keir Starmer was now at the helm, honourable and lawyerly. After a number of missteps, bad calls and U-turns, his popularity sank so low that by the local elections of May 2026 the Parliamentary Labour Party had decided he could not lead them into the next general election. A few weeks short of two years as prime minister, he resigned.

It is likely that Andy Burnham will become the next prime minister. Meanwhile, in one way or another, the office has been haunted by the banshee cries of Nigel Farage, first in UKIP, then in the Brexit Party, and now in Reform.

The Myth of Control

One of the things Brexit was supposed to give us back control of was our borders. It now transpires that the problem was never Europe, but policies within our own domain.

Whereas European immigrants were near enough that they could, if they wished, return home every weekend, the immigrants now arrive in larger numbers from further afield. They cannot return home every weekend; they are full settlers with family ties that must be accommodated if their services are to be procured for the nation.

Likewise, Brexit was supposed to ignite a bonfire of rules, mostly from the EU. Yet to trade with any trading bloc, we need alignment and agreement on standards.

We were once involved in crafting those rules, but for the purposes of ease of business, the very rules we thought we could jettison must now be absorbed into our regulatory system for seamless commercial activity. We are rule takers where we were once rule makers, in concert with the community to which we belonged.

No Justice in Sight

Then there is the question of how the UK economy has suffered since Brexit, with the loss of about 6% in GDP. You may not be able to call Brexit a failure, but if it looks like one and walks like one, there can be no other conclusion.

The fight for the soul of the country continues as we struggle to get the facts before the people, who are bombarded and cajoled into working against their self-interest, sold easy solutions to complex problems.

We cannot defeat geography. Europe is our closest trading partner, and a softening of Brexit, with a bold and courageous defence of the associated policies, is needed.

They say a majority would now vote against Brexit. The fact is, the perpetrators of this travesty have never been held accountable, and it is doubtful we'll ever get justice for the harm they caused. What a wasted decade.

A Google NotebookLM AI Podcast on this blog

Essential Snobbery 101: The King's Button

The King's Button

Edward VII was reputed to be a man who loved the pleasures of life, and his girth bore witness to this. At the table, he would leave the bottom button of his waistcoat undone, a practical habit that lent itself to ease and spared the garment the wear of exertion or extension on account of eating.

Observers at the table, nobles and servants alike, must have noticed this, and so it became the style. The party prince who became king after Victoria's long reign did it, and so should his subjects; consequently, this was deemed the way to dress. In time, the habit travelled beyond the waistcoat to the jacket and the suit, where it endures to this day.

How Custom Passes

The role of observers, those who watch a habit harden into a custom, is important to understanding how matters of style and taste are passed on. The observation must occur in close proximity and with a semblance of regularity, if one is to distinguish the trendy and the customary from a mere slip. The same applies to conduct, communication, and comportment, along with the courtesies that attend them.

A Quiet Decline

Recently, as I have gone about my own pursuits, it has come to my notice that elements of style and taste are not as commonplace as one would hope. Many gentlemen, and I use the word liberally, from the young to the much older, wear their jackets with every button done up.

There are times when I have had the urge to point this out, but such a thing is only acceptable with people you know, not with strangers. It suggests that the knowledge simply is not there. Style, however, is not optional; it is descriptive on sight, speaking before a single word is uttered.

There Is No Finishing School

I have been fortunate to keep the company of those who know these particular things, and to learn from them: leaving the lowest button undone, undoing all the buttons when sitting down, how to knot a tie, how to match a pocket square, and so on.

There is no class or finishing school for this. You learn it through association, something you have seen your father, uncle, brother, friend, mentor, or teacher do, where on occasion they have extended a hand to make that slight adjustment which separates you from a ragamuffin.

The Quiet Inheritance

There is a name for what I am describing, though I had circled it for years before I learnt it: cultural capital. It is the quiet inheritance of knowing, the accumulated sense of how things are done, passed not through lectures but through living alongside those who already possess it.

Unlike money, it cannot be handed over in a single gesture; it must be absorbed slowly, through observation and the occasional corrective hand on the shoulder.

What troubles me in my own observation is that this transfer appears to be faltering. The fathers, uncles, and mentors who once made that slight adjustment seem fewer now, or perhaps less inclined, and so a generation arrives at adulthood with the wardrobe but not the wisdom, the garment but not the grammar of wearing it.

Style as a Map

It is strange how a mere observation can tell of the road you have travelled, and how, in certain settings, it becomes the key to gaining access or being barred.

I want to be clear that this is not a plea for gatekeeping; I take no pleasure in barriers, and I would sooner extend the hand than withhold it. Yet I would be dishonest to pretend that appearances do not, quietly and often unfairly, dictate access.

A door opens or remains shut, an introduction is offered or withheld, a judgement is formed and acted upon, all before a word has been exchanged.

The cruelty of it is that those most affected are frequently the least aware it is happening, mistaking the closed door for bad luck rather than a code they were never taught to read. To name this is not to endorse it. It is simply to acknowledge that the rules exist, that they operate in silence, and that ignorance of them is rarely the fault of the person left standing outside.

No Personal Fault

This is not to be judgemental, even towards the utterly pretentious; eventually, that discomfort with one's appearance is betrayed by embarrassment. It is upward mobility expressed in acquisitive adornment, yet bereft of the quiet sophistication of the how and the why.

Whether this calls for a school of style, I cannot tell. It is not as though these people considered consulting the largest repository of knowledge, the Internet at their fingertips, to ask questions of style and taste as readily as they might ask for a recipe.

Invariably, as my gaze falls upon these occurrences, I am reminded that not knowing, or not caring, is not so much a personal fault. You were simply not privileged to keep the company of that kind of positive influence.

The Shops, and Where I Stand

Let us not forget the shops. I will not step into a suit shop where a mannequin has been improperly attired, as it suggests the staff have paid no attention to detail.

In one such shop, I asked to be fitted, but I was dismissed to the fitting room as though I were trying on a casual shirt or a T-shirt. I did not waste another minute there.

I do not intend to become a consultant on style. Rather, I will stick to the comfort of the familiar.

An Edwardian Inheritance

It is fitting, then, to return to the man who began all this. The Edwardian period was one of transition in dress as much as in everything else. For both men and women, this period balanced structured luxury with newfound freedom of movement. The rigid formality of the Victorian age was loosening, and comfort was beginning, quietly, to earn its place alongside propriety.

Edward VII's most enduring legacy was the tradition of leaving the bottom button of a waistcoat undone, a habit that has since transferred to jackets and suits alike. We observe it now without a thought for its origin, which is rather the point.

A king's button was only ever a habit that others chose to read, to copy, and to pass on. The grammar of how we dress is nothing more than a long chain of such small observations, handed down from one watchful eye to the next, until the day the chain is broken, and someone arrives, jacket fully buttoned, with no one left to make that slight adjustment. Just look away.

Blog - Essential Snobbery 101: The rules on suit buttons (April 2014)

A Google NotebookLM AI Podcast on this blog

Essential Snobbery 101: The Etiquette of Getting Caught

The Art of Discretion

If one were to court controversy, one could say that infidelity is congenital or consanguineous, but rarely learnt or taught. The debate around that is for another forum.

However, the tendency to stray must surely come with the essential common sense of, first and foremost, not rubbing your partner's nose in it. This means according those liaisons the respect of keeping them at a distance, and being as discreet as you possibly can in order to avoid getting caught.

History, as I have read it, would suggest that the Victorians and Edwardians who kept mistresses made sure their spouses were not disadvantaged in dignity, position, attention, or latitude. It was usually a case of knowing without feeling threatened.

A Cautionary Commotion

What I cannot abide are those who break the rules in wholly unforgivable ways, such as placing their matrimonial bed at the very centre of the travesty whilst hoping not to get caught. What on earth are you thinking? The follow-up question is unprintable.

I was once privy to a narrative relayed to me of a commotion that brought the police to a home, the cacophony having included the shattering of glass, and whatever else might have been flung, in both words and objects, when a hapless fool was caught in the act.

His wife had gone away and was not expected back until the weekend; she returned the previous night, however, only to find her husband canoodling with another woman. There is no need for a graphic replay, at the risk of sensationalising the matter with the aplomb of a village rag.

A Failure to Plan

There must be a reason why she did not telephone ahead to forestall what might have been her suspicions of something untoward. Some people spare themselves the possibility of such situations by making allowances, in the spirit of "out of sight is out of trouble".

He, however, in his careless and carefree manner, played the oily mouse whilst the cat was away. He should have planned his rendezvous for a motel, or somewhere far from home, yet he did not.

Stepping back to view this from an objective angle, the effrontery and audacity required to bring someone else home should always have come with the forward planning of a number of things. First, an alert system that detects proximity, so as to avoid an encounter. Then, easy sequestration, should your spouse enter the house when there is no chance of escape.

Hiding the Evidence

You cannot put the interloper on the window ledge outside if you are on the tenth floor, especially if that was not intended as a final goodbye. Slipping them under the bed, behind the curtain, or into the wardrobe are far too common as places to hide, and so to be found. Just roll a bottle under the bed; if it does not come out the other end, take a look.

Someone suggested the oven or the fridge, which left me thinking of the double-jointed contortionist who performs at the Victoria & Alfred Waterfront in Cape Town, doing such unimaginable things with his body that the spectacle is too suggestive for a polite audience, and yet impossible to look away from.

Perhaps the clothes basket could help, and what you would need next is a snake charmer to play the pungi as your quarry wriggles to the swaying hypnotism of the sound, lifting the lid of the basket and unleashing the scandal that would ensue. You may not be prepared for the confessions.

If you do not have a number of well-planned escape routes, no amount of explaining would extricate you from a complex situation that would serve as entertainment for your neighbours, and inspiration for this very piece. You got caught, pants down, and the only thing you might ever salvage is your dear life, by the skin of your teeth.

A Google NotebookLM AI Podcast on this blog

Men's things XXXIV: Saving the life, and saving some lifestyle

The Shadow of Mortality

The pall of mortality hovers like a dark cloud at certain times, but you cannot dwell on that feeling at all. Every time you escape the dread it portends, you are grounded by the good fortune of survival and by the uncertainty that reliving it might present.

Above all other questions, it did occur to me whether I had it in me to face another cancer diagnosis. As much as I presented as stoic two years ago, my concerns and anxieties were a rumbling thunderstorm in my mind. I reached for comfort in sermons and in the faith that things, no matter how bad, would be fine.

A Diagnosis Already Known

However, when I saw the consultant at the Christie Hospital in mid-June 2024, it was not to discover anything new. I had already known for a week that adenocarcinoma of the prostate had been diagnosed, because my medical notes from another consultation had been merged with the findings from a biopsy taken three weeks before.

The doctor who made the mistake offered to redact the notes, but how do you unsee the facts as they were presented? The damage of letting the information slip through, without the essential conversation in a controlled setting, had been done.

I was reviewing the consultant's notes yesterday, and I wondered whether there had not been a haste to act, considering the stage at which the cancer was found, given their recommendation of active treatment as opposed to active surveillance.

In the haze of the moment, you do not see everything your medical results indicate; you grasp at the headline and let the detail blur. Looking at the same notes two years on brings a new realisation, a clarity that was simply not available to me then. Yet what can one do now? The decision has been made, the treatment taken, and hindsight, however sharp, cannot rewind the clock.

Registered Without Consent

I attended the consultation with a friend, but what shocked me still more was that, once cancer was diagnosed, I was immediately added to the National Disease Registration Service (NDRS), which comprises cancer diagnosis and analysis along with congenital anomaly and rare disease registration. No one told me I could opt out.

Then, on the matter of cancer, I have always felt that all who have encountered it are treated on the basis of the body of knowledge acquired from survivors and non-survivors alike. We are rarely pioneers of this unfortunate human condition.

Brian, because of his exposure to the medical field, would have been aware of what was developing, but I wanted to tell him when we met up in Cape Town, and that was just over a week away.

Weighing the Options

Meanwhile, between the visible and painful skin cancer of 2009 and the invisible, seemingly benign prostate cancer of 2024, I was totally conflicted. I was hoping that chemotherapy, of which I already had some experience from the last time, was an option, but I soon learnt that the only options were surgery or radiotherapy.

The treatment I eventually had was hypofractionated radiotherapy, effectively External Beam Radiotherapy (EBRT), over 20 weekdays in September and October 2024.

This week, NHS England will begin to offer a more targeted radiotherapy treatment for prostate cancer called Stereotactic Ablative Radiotherapy (SABR). This was first proposed in 2021; it's only five years late.

This focused treatment is down to five doses over a fortnight and lends itself to fewer side effects. [Sky News: 'Cutting-edge' prostate cancer treatment to be rolled out by NHS from next week]

Proposed Patient Pathway
Stereotactic ablative radiotherapy (SABR)
for patients with previously irradiated, 
locally recurrent primary pelvic tumours [PDF]

Progress and Its Price

More recently, the website of Elekta, the company that supplied the radiotherapy equipment for my treatment, features equipment that could offer the same radiotherapy in two fractions. MR-guided adaptive radiotherapy even promises minimal side effects compared with other interventions.

The selling points are that it lowers acute Gastrointestinal (GI) and Genitourinary (GU) side effects while better protecting erectile function. That is the elephant in the room that rarely gets talked about, where cancer treatment saves the life yet does little to preserve the lifestyle.

Then, one must acknowledge that these advancements in technology are welcome progress in tackling these issues. One cannot live in the regret of not holding off on essential treatment to wait for better options to select from. You work with what is available, and you study the changes that come along.

The Elephant in the Room

Even as I insisted on not being co-opted into a form of chemical sex to ease the issue of sexual dysfunction, I was invited to take a prescription of sildenafil citrate, typically at half the normal strength. I feel like the boy of fifteen whose first job was in a brewery, working in the laboratory, where the first wort was said to be an aphrodisiac.

Hey! Medicine expects that, if you can get it up, you already have the sexual confidence for everything else to follow. I beg to differ, as the package gathers dust in my bedside cabinet.

Blog - Men's things XXXIII: Prostate Cancer Screening and UK Black Men

Blog - Photons on the Prostate: Three Things I Wish I'd Known

Blog - Men's things: Prostate Cancer blogs

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