epmo

URGENT MEMORANDUM

To: All Coffee Call Centrre Organisers

From: National Industry Coffee God (Make mine a double shot latte)

It has come to my attention that an increasing amount of members are utilizing the Call Centre services. While this could be attributed to Coffee Club Organizers and Lead Coffee club Organisers promoting the service, there is no evidence that any of our members have been contacted by any of the aforesaid for at least nine months. It has also come to note after careful analysis of  incoming and outgoing calls routed by our free-call 0800 COFFEE number that an alarming amount of calls are being diverted offsite to 0900 ACT-ACT.  Each diverted call costs our organization the cost of a flat white in Ponsonby, not an insignificant expense. ACT as you know is an acronym for Anti Coffee Time. This organization advocates for the abolition of free coffee, stating there is no such thing.

In future all calls received by the Call Centre will not be diverted to any other number other than the cafeteria and only at times when call centre organizers are not actually there, all other times the calls will be diverted to an answer machine. This is to minmise the risk of  members actually making contact with  paid officials of our organization. Remember we didn’t get to where we are today by the effective resolution of our members problems.

With the assistance of one of your colleagues I have drafted a standard call centre script for members that actually manage to get through to the call centre.

Member: Hello

Organiser Hello

Member: Can you help me please

Organiser: Depends

Member: I am having problems with my boss

Organiser: Ain’t we all

Member: Quite a serious problem actually

Organiser: Hang on mate, I have to put you on hold for a while. (At this point you leave your desk and head for the cafeteria)

After 5 minutes of muzak a prerecorded message from one of our most experienced members of our legal team will start detailing a 10 point plan for legal dispute resolution within the workforce.

The call will then be redirected back to your phone. If the member is still there you are to actively encourage them to harden up and sort the problem out for themselves. It is essential that you instill in them the values of self reliance, independence and if necessary encourage them to kiss the arse of their boss.

Remember, there is not enough Coffee to share it with everyone, we have been successful in maintaining our coffee consumption by tapping into our reserves and raising the membership fee to almost keep pace with our expenditure. We must remain optimistic and in due course it will be decided that a number of Coffee Consultants will be hired to resolve our looming liquidity problems. On all previous occasions that Consultants were hired Coffee consumption increased spectacularly, I see no reason to doubt the same will occur during the next round of consultations.

CONFIDENCE IS HIGH

How you trek the Annapurna in Nepal circuit depends on which country you were born in. The circuit is a 200 mile journey around the Annapurna Himal, up the Marsyangdi River valley to Thorong La, a 17,700′ pass (5416 metres), and down to the Khali Gandaki River valley.

Russians enjoy a rigorous workout every morning where all sorts of calisthenics and gymnastics are performed. Mostly these exercises are performed with the barest minimum of clothes on. The comrades face each other in a large circle and begin with a slow stretch, followed by a quick glance over the shoulder to ensure that as many people as possible are looking on. The stretching gives way to serious grunting, heavy breathing and multiple extended long limb manoeuvres, similar to the twister party game. As the exercises progress, more layers of clothes are removed and in the chilly air of 3000 metres ASL they positively steam.

The Spanish begin by eating a boccadilla and putting socks on before they slip into their sandals.

Canadian women (all 60+) after a long sleep in, prepare by purchasing the most amount of food possible to eat, share all their food liberally with each other, ask questions about each other’s health and well being, steer any conversation away from politics and religion, smile politely and encouragingly at the Russians, scan the mountains constantly to compare them with their own Rockies and somehow manage to trek slower than any other group, yet finish ahead of everyone at the end of the day.

Brits – you don’t really see them at all.

Israelis haggle over the price of breakfast, do not talk to anyone outside their group, unless it is to haggle. Talk loudly, push ahead of everyone when they order food and complain loudly that the food is not kosher.

French travel in family groups, are openly relieved when they discover you are not English, constantly compare the Himalayas to the Mediterranean coastline and smile a lot to make up for their lack of English comprehension.

Australians, the nouveau riche of the travel circuit, travel in the opposite direction to all other trekkers, fly, drive and jeep to the nearest drop off point, don the absolute latest in designer outdoor sports apparel, climb as quickly as possible to the highest point, relay to all who will listen that they are Australian and that they work in London, are easily drawn into conversations about how they were the only country to actually see any combat in WWI and WWII and vanish, you often find them later in a bar with several Asian women.

Irish eat a hearty breakfast, quietly watch the daily shenanigans, smile a lot and get busy climbing. If you are an Irish woman, in addition to the above, you also use your God endowed powers of observation to analyse accurately the motivational forces behind every action, both realised and potential, of every other person they come into contact with, and quietly, but confidently, relay this information to you when you least expect it, thereby keeping you constantly on your toes.

Kiwis – we just climb.

If reincarnation is a reality then my preference is to return as a dog. India has the highest concentration of the world’s poor within its borders, approximately 350 million people live below the poverty line. In Benaulim, Goa, a young lady with her baby on her hip decided to beg outside a cafe. The cafe was frequented by European tourists and on this first day of 2008 it was full. It must have looked a good spot to tout for the money needed to purchase the necessities of daily life. A kindly lady became quite agitated extracted a knife, promptly cut off the bottom of a plastic bottle and placed the container now filled with water next to the begging Mother and child. The dog next to the Mother sniffed at the water and decided not to drink from it, instead he looked pleadingly into the eyes of her benefactor and she produced some dog biscuits. Doggy sniffed, ate half of what was given and trotted off down to the beach to hang out with his mates, maybe chase a flying frisbee, cool down in the gentle surf, lie under a swaying palm and when hungry go for a bite to eat at a local cafe. Meanwhile the Mother and child were completly ignored and before one of the less tolerant tourists dispatched her with ‘Cello’ – hindi for ‘piss off Pakistani’ – she shuffled up the road for another bite at the lucrative tourist market.

The enchanting land of Thailand, is truly a beautiful country. Palm lined beaches, beautiful green countryside, majestic hills and mountains, bustling cities and idyllic villages. The people are gentle, welcoming and kind, a raised voice is seldom heard.

I was flying out from Bangkok and discussing the virtues of the ‘Land of Smiles’ with a young Finnish gentleman, Ari. Ari has been living in Thailand for five years studying and co-directing a liquor importing business in Bangkok. He has three degrees and is now studying for a masters. At the age of 17 he was diagnosed with leukemia and managed to survive. He has since traveled much of the world and leads a remarkably interesting life. He has an aversion to cold weather and like many Finns I have met, has a deep and abiding affection for hard liquor.

We settled into our fourth Remy Martin that he had managed to secure from the smiling but now guarded eyed flight attendant as we flew over Bangladesh. He relayed the story of a Canadian, Steve (not his real name), who, while holidaying in Thailand fell in love with a beautiful Thai lady. He returned to Canada but found that he had left his heart behind. He made arrangements to return and love blossomed. He sold all his belongings in Canada and settled into a new life with his beautiful partner and domiciled himself in Thailand. They were soon married and he used the small but significant equity he had from his former home in Canada to purchase a new home in a nice area not far from a beach. His Thai bride was truly happy. After several months of post wedding bliss a disturbing trend emerged. Many of Steve’s wife’s friends would turn up and stay for days on end and there were many parties with much alcohol consumed. Steve became uncomfortable with the situation and attempted to address the matter with his bride of a few months. An argument followed and Steve was stabbed with a pair of scissors just above his knee. He sought medical attention, received multiple stitches and after discharge from hospital returned home. His wife was in no mood to discuss the incident with him and proceeded to stab him with a knife in the site of the still healing wound, this time much more serious damage was inflicted and Ari told me that Steve was still limping six months after the stabbing. Ain’t love grand! When you are able Steve I suggest that you RUN FOR YOUR LIFE.

Of course not all Thai woman are like Steve’s wife. The Bangkok Post tells the story of how a Thai Policeman went out to dinner with an escort, near the end of the evening, the escort refused to have her photograph taken with the Police Officer, she instead insisted on leaving on her own and began to walk home. The Police officer, with two of his work colleagues followed her, cornered her in an alley and hacked her arm off at the elbow. After three years of investigation it was still being determined by the Police whether charges were to be laid against the Officer. The Police Chief did state that ‘Charges were likely’. Some of the men are handy with a knife too!

Trekking in Chiang Mai – Thailand

‘How did the trek go mate?’ ‘Fantastic, I totally recommend it’ replied Chris, a tall skinny 20 something Australian, he and his partner, Tik, had been in Chiang Mai in Northern Thailand for a few days and had decided to participate in a three day organised trek in the Chiang Mai Province. They had recently traveled through Japan and Korea and were loving the laid back atmosphere and the genuine friendliness of the locals. ‘The scenery was amazing and we had an awesome trip down the river on a bamboo raft.’ We decided to discuss their latest adventure over a few beers at the Guitar Man, a local bar that plays Rock and Roll and Blues to a good hour most nights of the week. We wandered over the Ping river from our Guesthouse and drank like we were Burke and Wills’ camels in the outback of Queensland after coming across a waterhole. Much was spoken, most of it nonsensical, and at 4.00 am the next morning we decided to call it quits.

Chris, Tik and another Australian, Andrew, on the long way back from Europe, all headed off to Pai for some more Indiana Jones type adventures in the local jungles. Upon their return to Chiang Mai Chris became seriously ill and had to be hospitalised. With excruciating pain in his joints and muscles, experiencing fevers and chills, diarrhea and vomiting he was diagnosed as having Dengue Fever. According to medicinenet.com, Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the “dengue triad”) of fever, rash, and headache (and other pains) is particularly characteristic of dengue. Dengue goes by other names, including “breakbone” or “dandy fever.” Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever.

Thankfully Chris wasn’t doing much contorting, probably less than John Howard will do if Maxine McKew wins his seat this Saturday in the Australian General Election, but he was extremely ill. He was put on IV fluid and closely monitored by the medical staff at McCormick Hospital and his faithful partner, Tik, stayed with him day and night until the fever broke and he started to recover. After visiting him in Hospital a couple of times I wasn’t sure if Tik was concerned only about his physical well being but was keeping a vigilant eye on the nursing staff as well. The Nurses all looked as though they could easily qualify for Miss Universe trials. I myself swooned and felt faint several times, the nurses were comparable to the Cafe owner I had come across in Glasgow with my Glaswegian friends Gary and James a few weeks earlier.

Dengue is not common in the Chiang Mai region, some long term residents have stated that this is the first case they have heard of ever. As there is no cure for Dengue except time, the best course of action is prevention through the use of a good Mosquito repellent and sleeping under a mosquito net.

The cost of staying a night in Hospital in Chiang Mai? 300 Baht plus medical expenses, less than a down at heel backpackers room in Bangkok. The total cost of Chris’s stay for eight days care totaled $600 Australian. He is now fit and healthy and planning an excursion into Laos.

To My Son, Jacob O’Grady

3 August 1991 – 29 March 2007

Jacob was born with spina bifida, a neural tube defect, it literally translates to ‘divided spine’. When the embryo is being formed in the womb the brain stem fails to form correctly leaving a ‘hole’ in the spinal column, depending on where that hole is, and the nature of the defect, a number of nerves are left exposed or damaged, this condition occurs in the first four weeks of pregnancy. The reasons are unclear, research has shown that if folic acid is taken some time before conception the chances of a neural tube defect occurring are reduced significantly. The highest incidence of spina bifida occurs on the West Coast of Ireland, the Irish and their descendants have a higher incidence of spina bifida than any other ethnic group in the world.

On Jacob’s death certificate it states that he died of pneumonia as a result of post operative immobility. This statement is true but it doesn’t tell the complete story of the events that led to his death. Prior to 2004 Jacob’s fine motor skills and upper body strength had been deteriorating, upon examination it was discovered that a syrinx, a high pressure area of cerebral spinal fluid (CSF), had formed in his upper spine, near the base of his skull. This was compressing the nerves in that area and was the primary cause of the loss of upper body function. The solution to this was surgery, specifically a procedure called Foramen Magnum Decompression, or alternatively the syrinx could have been shunted directly. Shunted means inserting a catheter like tube into the area to release the pressure and provide an outlet for excess CSF. It was decided that a Foramen Magnum Decompression was the best option. Jacob underwent this surgery in February 2004, it was not successful. Instead he deteriorated significantly and he required a further 15 neurosurgical revisions. Jacob who had managed to learn to walk with assistance from a walking frame, could now no longer walk, over the next few months he underwent multiple operations.

Jacob was a patient of Starship Children’s Hospital. The nursing staff at Starship Hospital were excellent, with the odd exception. Of particular concern was the fact that Jacob was discharged too early on many occasions, he was deemed well enough to go home, only to be returned a few hours later and needing to undergo emergency surgery.

In the following months as Jacob’s condition deteriorated an agreement was struck after a meeting with the senior consultant in charge of Jacob’s care and multiple members of staff at Starship on an agreed care plan and how to best proceed with Jacob in future dealings. The charge nurse of the ward, who is no longer employed there, and who did not consider it necessary to attend the meeting, decided to unilaterally alter the agreement as it did not suit her. Jacob and his family suffered as a result.

Jacob would get well for a time and then decline rapidly, it was discovered that another syrinx had formed in his brain stem, just millimeters away from the one that had been shunted after the Foramen Magnum Decompression. It was decided to monitor Jacob closely and review his condition as time went by. On boxing day 2004 Jacob underwent further surgery, and again in January 2005, in February 2005 he had recovered well enough to travel to Australia, and he had a fantastic holiday on the Gold Coast in Queensland.

In July 2005 he had to undergo surgery again. Once again it was not successful, as Jacob was living in Hamilton at the time, Starship decided to discharge him into the care of Waikato Hospital. Waikato Hospital is an excellent hospital, unfortunately at that time their was no neurosurgical ward and little expertise in dealing with children with Jacob’s condition. Jacob was misdiagnosed and the prognosis was that he only had weeks to live. I had been insisting on a second opinion from Starship Hospital, and the manager of Surgical Services had agreed to arrange one. It took 13 weeks, and multiple requests, before a second opinion was given by a senior Neurosurgical consultant. The first time the opinion was given, no mention of death or dying was said. The Consultant had been unaware of all the chatter surrounding Jacob’s supposed date with the Grim Reaper. I asked him directly if Jacob was dying and he said ‘I can’t guarantee he won’t be run over by a bus, but he is not dying from this condition’. I immediately called the organisation that were providing palliative support to Jacob and his family. They came at once, private discussions were held, which I was excluded from, with the local Waikato Doctor and various members of Jacob’s family and it was decided that Jacob was indeed dying, despite what the expert told us, and shortly after, my sister found people having a serious talk with Jacob, and getting him to write his will. My sister intervened and put an end to that nonsense, she didn’t tell me the events of that day, I didn’t find out till much later.

I once again had to request a second opinion, and this time I would ensure that the relevant people would be present when the opinion was given. The MRI scans needed for the second opinion were lost in transit from Starship Hospital three times. They miraculously turned up when I informed the then Manager of Surgical Services that I would be arriving by car to pick the scans up myself and on my way back I was going to drop into Television New Zealand and TV3 and tell both networks of the sort of treatment Jacob was receiving. When they did arrive they were thumbnails and not adequate to make a proper assessment. However the consultant cast his trained eye over them, and some others that had been taken more recently at Waikato Hospital, and it was told to all present that Jacob would live. He was well enough to go home with me a couple of days later. We watched South Park the Movie and had a great laugh.

In March 2006 I moved to Auckland, two weeks later Jacob came to live with me permanently. Jacob had been holding his own for several months and was relatively stable, he suffered from ongoing headaches, significant hearing loss and his vision had become impaired. As one surgeon stated – he was stably unwell.

In May 2006 he became seriously unwell, he was admitted to Starship Hospital, they kept him in for observation, in the meantime they had reneged completely on the ongoing care agreement that had been made in 2004, no reasons were given. Jacob was deemed well enough to be sent home. His condition continued to fluctuate, some days he was OK, mostly he was chronically unwell. Jacob was admitted to Starship on multiple occasions over the next four months, they treated the symptoms, for nausea he was given the appropriate anti nausea drugs, for headaches he was prescribed pain relief. The consultant surgeon in charge of his care referred him to psychiatric care to see if there was anything that could be done for him. Fortunately it was determined that Jacob’ s feeling unwell wasn’t able to be treated by the Psychiatric team. At no time during this four months was Jacob given an MRI. CT scans were taken that showed the syrinx in his fourth ventricle had increased, but the surgeons didn’t consider it to be significant. In fact the enlarged syrinx was the primary reason for Jacob’s condition.

Jacob was scheduled to have bowel surgery, which would assist him in becoming independent as he progressed through life. Late September he was in Starship, and was about to be discharged, I asked if he was well enough for the surgery scheduled in Waikato Hospital, the registrar on the Ward said that in his opinion he was. Jacob was discharged that day from Starship, and I took him to Waikato Hospital in my van. On the way down the van broke down and I had to ask my sister to pick us up and take us on to Waikato Hospital . We broke down in Pokeno and Jacob and I had one of their legendary ice creams each while we waited for my sister to arrive. Later on in the day we arrived in Waikato hospital to find out that the operation had been cancelled, but no one had bothered to call and inform us. The cancellation took place as a result of one of the palliative care team assigned to support Jacob and his family had stated to the Waikato team that Jacob was unwell in Starship Hospital and wouldn’t be able to make it, this was a member of the same team that initially ignored the second opinion given that Jacob was not dying.

The operation was postponed for several weeks. He eventually underwent surgery and the operation was successful, afterwards he returned home to Auckland with me and a few days later he became seriously unwell, this time he was admitted to the Neuro Surgical Ward in Auckland Hospital. He was under the same surgical team, he was in a different ward and no longer part of the children’s hospital. Jacob became very ill, he lost all his strength, was not able to talk clearly, and became unintelligible, he went blind in one eye completely and could only see a few inches in front of him with the other, he lost most of his hearing and developed a severe scoliosis, he was vomiting, and was not able to hold any food or drink down. He was scheduled to have ongoing treatment for his recent bowel operation but was not able to attend because of his condition. The relevant ward in Auckland was contacted and they paid Jacob a visit on two occasions and a care plan was being developed, I was told, that would ensure he would be OK. I didn’t see them again for quite some time, When I did see them the site of his operation had fissured and his bowel op was no longer working. In the meantime Jacob continued to deteriorate neurologically. His Neuro consultant visited and asked if he had been vomiting, I said no, and he said he can go home. He seemed to miss the fact that he wasn’t able to eat, which in my lay person observation would have meant there would have been very little to vomit. I asked the consultant about an MRI, he said it wasn’t necessary, then he left. I was left speechless and feeling helpless. At this moment I believe the full weight of my Irish ancestry came to bear and I went looking for the consultant, he had disappeared through one of the security controlled doors that I had no access to. I went through the Hospital and came across a significant number of the Neuro Surgical Team at the lift on their way back from coffee. I explained to them that I was not impressed with the level of ‘Doctoring’ Jacob had been in receipt of for the last several months and that if they did not take significant steps to improve the situation immediately that I would be exposing them to the media with accusations of gross negligence. They were given the afternoon to lift their game. Later on that afternoon Jacob received an MRI and the most thorough examination from another Neuro Surgical consultant I have ever seen Jacob undergo. In his opinion surgery was necessary.

The surgery to be undertaken was very high risk, the alternative was do nothing and die slowly. Jacob underwent emergency surgery in the wee small hours of the morning on Labour Weekend. The operation was a success, Jacob improved dramatically, within a day he was singing, laughing and cracking jokes. He was in the best condition Neuro-wise that I had seen him in nearly three years. I had got my boy back!

Jacob was then discharged and transferred to the General Surgical Ward of Auckland Hospital, one floor below. The reason Jacob hadn’t been seen by them for a week or so was because they mistakenly thought Jacob had been discharged, as well as this there was a Doctor in Starship Hospital General Surgical team who knew Jacob well and when I asked the nurse to contact her about Jacob’s situation the Doctor ignored the request. I guess Doctor’s need time to have coffee too.

The General Surgical team were to sort out the complications to his bowel operation. As a considerable amount of faeces was oozing from the fissure it was decided to help reduce the output and give it a chance to heal that he would be put on a Parenteral feeding system. This is all very high tech. The ward has several posters with photographs of those qualified to carry out this procedure in several prominent places around the ward, it’s sort of like going into McDonalds and seeing those Employee of the Month signs as you order your Big Mac and Fries. Using the Parenteral Feeding System the stomach is effectively bypassed by placing a tube into one of your arteries and a cocktail of readily blood absorbable goodies is passed into your body. The tummy and bowel have a rest and the bowel is given a chance to heal itself.

I had not had much sleep for the previous few weeks as I needed to ensure that the Neuro team were doing their job properly, I was feeling reassured by the staff in this new ward that everything was fairly routine and that Jacob’s needs would be looked after, so I decided to go home and have a sleep. When I returned the next day Jacob was very uncomfortable and was complaining of a full bladder. (Jake needed help with emptying his bladder) I had left instructions with the staff in writing as to what was required in regard to his toileting needs. These instructions were completely ignored and Jacob was left with a seriously full bladder for several hours. Not only was he extremely uncomfortable, but his bladder was at risk of perforating. The staff were clever enough to take my complaint seriously and Jacob was not left with a full bladder again for the remainder of his stay.

In the meantime the faecal oozing only increased, which was opposite to what I was told would occur. Jacob was confined to the bed as a consequence of the feeding tube in his neck, and despite multiple requests for a suitable mattress, which were all ignored, he began to develop bedsores and was showing signs of congestion in his chest. I had been talking with Waikato Hospital about the situation and as soon as Jacob had been discharged from Auckland hospital (deemed well enough to go home) he was admitted to Waikato Hospital. He was treated very well there, they got on top of his congested lungs immediately, made sure he had a suitable mattress and solved the faecal oozing problem by administering an enema which relieved him off the constipation he had been suffering from for the past few weeks. The ‘high tech’ parenteral feeding treatment was a complete waste of time, and Jacob had been discharged from the Auckland General Surgical Ward in a far worse condition then when he had been admitted.

Jacob recovered well from the neurosurgery, he continued to improve over the next few months, he no longer needed a cocktail of drugs that kept pain and nausea at bay. His strength continued to improve. He was able to transfer himself from his wheelchair into his bed, something he had not been able to do for over a year. He had once again become a happy young man. In the McLean Centre, Mount Roskill Grammar School, there is an excellent gym. Jacob could often be found there working out on the weight machine. His strength had improved to the point where he was starting to walk again with help from a walking frame. He had not been able to walk in nearly three years. He still had not recovered to the point he had been prior to the Foramen Magnum Decompression surgery in February 2004, but all indicators appeared positive. We had every reason to be optimistic about his future.

In late February 2007 I noticed that his energy levels had diminished, he became very tired in the afternoons and was happy to go to bed after coming home from school. On March 7 an appointment for an eye test was scheduled. Jacob attended and it was found that his eyesight had deteriorated significantly from a test taken a few months earlier. The eye specialist was baffled as to why this could be. His hypothesis was that a shunt was blocked. Within an hour Jacob had begun to vomit. We went to Auckland Hospital and he was admitted.

Two of the neurosurgical doctors examined Jacob and theorised that his left ventricular shunt was blocked. Jacob had had this shunt inserted many years earlier and it thankfully had not caused him any trouble since 2001. I was relieved to hear that this was the problem, as the surgery entailed to revise the left ventricular shunt is relatively low risk compared to a shunt revision at the base of his brain, or fourth ventricle area, the area which had caused him so many problems in the previous three years. A CT scan was ordered and reviewed, and it was decided that the best course of action was to operate to relieve the pressure. The CT scan did not actually show that there was a problem with the site of the proposed surgery, but when combined with the symptoms he was displaying it seemed best to proceed with the surgery. The symptoms he was displaying could have easily been caused by a blocked fourth ventricle shunt as well. I signed a consent form for the surgery to proceed, and all that was required was for a time slot to be made for it to proceed. Surgery was scheduled the next day, by this time the hospital had lost the consent form and another one had to be signed. Just before they took Jacob through for surgery he said to me that he didn’t want it, I reassured him that everything would be OK, and that this surgery was simple compared to what he normally had. I said goodbye, and Jacob, the tough kid that he was, looked at me defiantly and gave me the finger.

Jacob came out of surgery, I joined him in the recovery room, he was more sluggish than normal and was not responding as well as he should have, I questioned the nurse as to what pain relief he had been charted, she stated morphine. I stated that morphine has often caused Jacob problems in the past, and that I had discussed my concerns with the Doctors and that another pain relief such as fentanyl should have been charted. She momentarily appeared concerned and then stated it, referring to the morphine, had been charted and proceeded to administer another dose of morphine. Jacob was discharged into the High Dependency Unit (HDU) on the Neuro Surgical Ward, he never became fully conscious and the next morning he slipped into a stupor, a near coma. A routine CT was ordered and this time it was discovered that the left ventricular shunt was well and truly blocked, Jacob underwent emergency surgery, and the original shunt was reactivated. There had been nothing wrong with the left ventricular shunt, it was not blocked, the surgery he had the day before had caused it to block, the emergency surgery unblocked it.
Jacob bounced back from his two surgical procedures, but continued to display symptoms consistent with a fourth ventricle shunt blockage. He continued to deteriorate, experiencing growing paralysis and severe head pain, he was administered morphine and had to be resuscitated. It was then decided that anything stronger than panadol should not be given. The surgeons were confident that he was recovering well, despite all his symptoms showing otherwise. He was kept in the ward for observation and moved into his own room. His pain continued to grow worse and his vision and hearing deteriorated significantly, he developed a severe scoliosis of his spine and his speech was becoming unintelligible. Jacob was in bed most of the time, on two occasions we went for a walk in his wheelchair to the café and hung out with the other patients, staff and hospital visitors. He would grow tired very quickly and needed to return to his bed for rest. I had been speaking with the Doctors when they did their morning rounds and voicing my concerns that the symptoms he was displaying were as a result of a blocked fourth ventricle, while I was not fobbed off as callously as a few months earlier, and they were well aware that I was well aware of what bad press could potentially do their reputations, they were cordial and stated that the MRI actually looked better than it had a few months ago, When I suggested that they weren’t comparing apples with apples they asked me to explain. I stated that the MRI of a few months ago was taken when Jacob was acutely unwell and that it showed an enlarged fourth ventricle, they agreed. I went onto state that the most recent MRI shows an enlarged fourth ventricle, but not as severe as the last one taken a few months ago, they agreed. I asked if it could possibly be that, post surgery a few months prior, the syrinx had all but disappeared because the operation was a success, and now what you are seeing is a syrinx, not as severe as earlier scanned, is now there as a result of a blocked shunt, it just hasn’t progressed as far as last time. They had no coherent answer. I lamented the fact that Jacob had never been given an MRI when he was well, as that would have been a good reference point to draw a baseline from. I suggested they take another MRI so they could indeed compare apples with apples. My suggestion was not acted upon.

Jacob continued to deteriorate to the point that he was not able to lift his arms, he was moved back into HDU for close monitoring. The pain medication he was on was not sufficient for him to find relief. Over the weekend his condition deteriorated, he was in intense pain, and my patience with the surgical team all but evaporated. On Sunday evening I insisted on an MRI, this request was flatly refused, instead an MRI was scheduled for later on in the week. On the day of the MRI Jacob went into a deep sleep for many hours, he awoke about 30 minutes before the scan. By the time of the MRI he actually seemed to be improving significantly. The MRI showed that the syrinx had collapsed around the shunt and had virtually disappeared. The registrar stated that this is the baseline needed to draw any future comparisons with. It appeared that the shunt in his fourth ventricle had unblocked itself, and the pressure had been relieved.

Jacob continued to improve, within a couple of days he was out of HDU and back in a room on the ward, His strength had improved, along with his vision and hearing, he was able to hold his food down and was off IV fluids. I was expecting to take him home in one or two days. That morning when the Doctors were doing their rounds one of them noticed Jacob was experiencing difficulty breathing, an X-Ray of his lungs was ordered and it was found he had acute pneumonia, the prognosis was that he had three days to live, he survived another eight and died peacefully in a room in the ward, surrounded by his family on 29 March 2007.

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The death certificate stated that Jacob died from pneumonia as a result of post-operative immobility. What it didn’t state was that the first operation was a mistake and caused his shunt to block, the second operation was to reverse the damage caused by the first. The post operative immobility was as a result of his fourth ventricle being blocked which caused him to be paralysed from his neck down for a substantial period at a critical time post op.

The same Surgeon who performed his last two operations performed the one in October 2006. He saved Jacob from dying then. As a result of the successful operation Jacob enjoyed a quality of life that he had not had for several years.

The Consultant that Jacob was under all his life was the one primarily responsible for Jacob living as long as he did, he saved his life on a number of occasions. Without the multiple surgical interventions performed throughout his life, approximately 30, Jacob would not have lived past his first birthday.

I believe the February 2004 Foramen Magnum Decompression was a mistake, and it was this operation that eventually led to Jacob’s death. I don’t believe any surgery should have been performed, Jacob’s condition should have been monitored closely and if he showed signs of a life threatening condition then a decision to operate or not could have been made then.

My advice to all parents of children in similar circumstances is to obtain a second opinion prior to any surgery required, and make sure you have very strong support networks around you for the duration.

Jacob wrote a rap song a few weeks before he died, I will leave you with his words.

Dad is trying to make it better I want to die the reason I don’t is beacause Dad and Mum really love me and they will miss me… I feel like killing myself now every fuckin time people look and laugh I fuckin hate that now I get headaches all the time I cant get back to how I was and I want to… I cant go back there now because the fuckin doctors fucked me up

RIP Jacob

Goatfell, Isle of Arran, Scotland

The lazy mist hangs from the brow of the hill,
Concealing the course of the dark-winding rill;
How languid the scenes, late so sprightly, appear!
As Autumn to Winter resigns the pale year.
Robbie Burns

“Would you look at the heather in the hills”

“She’s a bitch”

“What do you mean, she’s a bitch? It’s beautiful”

“I don’t think she’s beautiful, although some poor sap might think so”

“Well I suppose beauty is in the eye of the beholder, but don’t you like the look of heather? You think the yellow gorse covered hills of New Zealand are nicer?”

“Eh? What are you talking about? I wouldn’t compare her to a noxious Scottish weed like gorse, but look what she did to Paul”

“Paul who?”

“Who do you think? Don’t you read newspapers?”

“What shite are you spouting now, Kiwi?”

“Liverpool’s favourite son Paul, pretty boy, McCartney. You Scot’s are an insular bunch, but he did a pretty good job on ‘Mull of Kintyre’ That certainly put the place on the map, before that all you had was the Loch Ness Monster. I suppose you think she’s wonderful then. Is it because she has a connection to Scotland and it’s OK to take him for millions because he’s English? I thought we Kiwis were one-eyed, especially about the Rugby, women’s suffrage, first to climb Mount Everest, split the Atom and first to land on the moon”

“First to land on the Moon, that wasn’t New Zealand – that was the United States”

“I thought our history teacher was talking shit, anyway I think she’s a bitch”

“Who?”

“Heather”

“Heather who?”

“Geez mate, you brought up the subject, have you been smoking too much hash or something? You have serious short term memory loss”

“What shite are you talking now?”

“Heather – Heather Mills, I think she’s a bitch”

“Fook sake Mon. You Kiwis are a strange breed”

More photographs

Dedicated to Mike

Welcome to the EPMO, the place you go when you are feeling like ‘Everyone Pisses Me Off’. This is first of all a travel blog, you will find tales of travels and cities that I have visited, and stories of my fellow human beings and all the things they get up to. Some of my best times have been experienced in various cafes around the globe meeting fellow travelers on life’s journey.

First up New Zealand, here are some observations on coffee drinking in the land of the long white cloud, Aotearoa.

The Coffee Critique

To be a true connoisseur in the art and science of coffee drinking not only must you have several years experience actually drinking it, but you must live for it.

True connoisseurs are actually employed on a permanent full time basis. Such organizations do exist. The employment benefits are comprehensive and generous, the career path is seemingly clear cut – but this is a trick for the novice, true addicts develop a repertoire of skills that propels them into public office, but the cleverest develop ways of not only being in employed to drink coffee, but actually manage to attain a state of caffeine nirvana where they are able to travel extensively and have all their coffees paid for by the organization they are employed by, this is in addition to all the other benefits of a highly paid job with extensive benefits that mere mortals would only dream of. I am talking about an elite group of people who are in fact Coffee Gods.
I myself was actually in the employ of one such organization for several years. I speak from personal experience. I have fallen from those lofty heights and am now confined to decaf and tea, health problems have caused me to eliminate all caffeine intake, I am now a loiterer in the lanes that house our coffee places the world over, still captivated by the enticing aromas that waft on the breeze, no longer able to imbibe of the delight that once held me captive in it’s embracing charms.

The structure of one such organization can be found in New Zealand. Head office is in Wellington, and branches are nationwide, the largest being Auckland. Christchurch has a boutique Coffee God office, which is undoubtedly representative of how all branches should actually be, sadly, it just doesn’t seem to work.

Below is the ORGANISATIONAL STRUCTURE displaying career path. Advancement is contingent on not only understanding the science of being a Coffee God, but more importantly becoming an artist in the execution of it.

ENTRY LEVEL: Trainee Coffee God
This is Coffee God boot camp. Here you are taken to Islands in the Hauraki Gulf to undergo rigorous training, many doubters are truly converted at this point, there is no going back for them. They literally see the error of their former ways and embrace their new found life. After dining at five star a la carte restaurants during their exhaustive training schedule, they are then ready to partner up with an experienced Coffee God. At this point they get the first inkling on how good life actually can be as long as the cappucino never stops flowing.

Coffee God
A good Coffee God works hard at their craft, first of all they have to justify why they need a coffee, and the reasons are plenty. First of all it’s the many unpaid volunteer subscribers to their organization (who actually provide the funding) who laud the coffee gods and occasionally call them with problems. Quite often the problems are so complex the only way to solve them is over a coffee. The other seemingly valid reason to spend time in a Café instead of visiting the subscribers is so you don’t stir up unnecessary problems by actually spending time with them. Coffee Gods at this level have already learnt the art of being invisible. The coffee actually comes out of your own pay at this level.

Lead Coffee God
This is a position for more experienced Coffee Gods, it is harder work here, but the pay is better. To become one you occasionally have to suck up to the boss and mow their lawns, otherwise not much difference to a coffee god. You occasionally have your coffee paid for at this level

Industry Coffee God
This position is under review, generally speaking there are lots of free coffees to be drunk at will.

Regional Operational Director of Coffee Gods
Where else should a Coffee God live but in coffee heaven? Nothing but free coffee in this position, plus you have all the time in the world to count your redundancy pay and plan for your retirement

National Secretary of Coffee Gods
The Coffees are on me boys, feel like having one in Sydney, Frankfurt, New York? Just book a flight and go.

Various Hangers on – Coffee Gods with no accountability.
Found in every organization, clever people with nothing better to do than ‘DRINK COFFEE’. If only that was all they did.

External Consultants
Technically they pay for their own coffees, they incorporate it into their fee. Hired frequently when the organization just doesn’t seem to be delivering Coffee fast enough.

[read on]