Ambulances

I've been riding around a lot in ambulances recently. I remebered an earlier blog about ambulances, back in 2019. I re-read it and it's much better than this one. It flows more easily and it's reasonably interesting in a Big Chief I-Spy sort of way. The sort of simple information with which you can amaze your friends and confound your enemies. So far as I can see there have been no basic changes to the legislation since I wrote that blog but that didn't stop me publishing this rewrite.

This piece is about the ambulances that are contracted by the Generalitat Valenciana, the Regional Government in, the region I live in. Every now and again Valencia put a contract out to tender and anyone interested enough to bid has the potential for providing the ambulance fleet for the requirements of the region. There are other ambulances, private and NGO ((Non Governmental Organisation). The private clinics and hospitals need ambulances to move their customer/patients around and other groups, for instance the Red Cross, run ambulances which can be hired out to provide part of the safety cover at events from half marathons to encierros.

There is national legislation about the construction, status and identification of ambulances and within that legislation there are some regional variations but, in general, everywhere follows a similar sort of classification which is pretty simple, pretty logical and easy to understand.

The first thing is that, discounting helicopters, rapid response vehicles and the like there are two broad classes of ambulance - those that can provide medical care en route, classes C and B, and those that don't, Class A.

The non-care ambulances, classes A1 and A2, are used to transport ill people around and are not designed to offer medical care to patients en route. These are the ambulances that take people to rehab sessions, to visit physiotherapists and the whole range of appointments at hospitals, outpatient clinics and the like. In the legislation these ambulances are divided into those that transport people on stretchers and those which are collective transport but nearly all the ambulances I've been in over the past six weeks have been halfway between. They have space for one stretcher, space for a standard sort of wheelchair and six or seven individual seats. They also have things like oxygen and defibrillators on board. The drivers will have a qualification as drivers and as first aiders having done a course that lasts about 350 hours. Sometimes these ambulances bear the letters TNA for non assisted transport. These ambulances are predominantly white in colour and have side windows in the rear of the van. 

The Assistance ambulances, class B or class C, are equipped to take care of sick people en route. These are the ambulances that will turn up if you dial the emergency number 112. There are a range of other numbers but 112 is the foolproof one for any emergency service.

The Class B or SVB ambulances are designed to provide basic life support. As a minimum they will have a crew of two, the driver and another person both of whom will have at least the Emergency Health Technician, TES in Spanish (Técnicos en Emergencias Sanitarias) qualification that requires a couple of thousand hours of study over a two year period and with regular updates and refresher courses along the way. These ambulances are SVB, Soporte Vital Básico (in Castilian) or Suport Vitál Basic (in Valenciano) and those letters are usually very obvious on the side of the ambulance. They carry a lot of medical kit on board.

The Class C or SVA ambulances (Soporte Vital Avanzado or Suport Vital Avançat) are designed to provide an advanced life-saving service. Again these ambulances will have a driver who holds the TES  qualification and, at least a qualified emergency nurse. The course to become a nurse in Spain is a four year university degree course. Most SVA nurses also do a further two years masters in nursing on top of the basic qualification. On occasions the nurse may be replaced by an emergency doctor or there may be three, or more, crew on the ambulance. A Spanish SVA Doctor will have done six years at university, a couple of years on a Masters in Emergency Medicine and another four years or so on a specialism like cardiology or intensive care medicine. By the time we're at that sort of staffing level we're into ambulances which are "medicalizadas", they're basically intensive care units on wheels and will sometimes bear the letters SAMU Servei d'Ajuda Mèdica Urgent, Servicio de Ayuda Médica Urgente Urgent.

It seems to me, though it may not be a figment of my imagination that as the ambulances become more serious the colour scheme utilises more yellow, there are still the red roofs and red lettering but the SVA/SAMU ambulances have swathes of yellow while the SVB only have a band of yellow colour.

One last thing thing came from chatting to one of the drivers who normally drove B and C class but had been drafted in for the transport ambulances to cover a sick colleague. It was about the use of lights and horns. If it's a real emergency, urgencia in Spanish because we lay folk know when something is urgent but it may or may not be an emergency, they will put the blue lights on but they really only use the horns to protect themselves when, for instance, crossing red traffic lights. The driver told me that time after time Spanish drivers would react in a very haphazard way if they suddenly found multi tone horns behind them and, as well as drop their mobile phone, they might do any sort of daft thing - so, better to arrive safe and a bit later rather than be the first vehicle on scene having been involved in another road traffic accident.

Esmorzaret

October 9th, is Valencia day, a regional Spanish  "bank holiday" to celebrate the day that King Jaume I entered the captured city of Valencia to bring it under the reign of the Kingdom of Aragon in 1238. 

In 2006 my friend Pepa told me, that on Valencia Day, one of the typical things to do was for lovers to give each other little handkerchief-wrapped bundles of marzipan sweets in the shapes of fruit, piulets, and tronadors (even having seen pictures, I don't know how to translate those words into English). So, on that first 9th October in Pinoso, I sneaked out to buy some from a local bakery, as a bit of a surprise for Maggie. I found all the shops were fast shut. It may be the tradition in the Valencia province of the Valencian Community, but it isn't here in Alicante. It's like paella. Up in Valencia, they have that bright yellow stuff with big prawns in it and round here we have a muddy brown-green paella with rabbit and snails. Ours is much better.

I get most of my news from the radio, but I also read an online, left-leaning newspaper, elDiario.es. Like all newspapers, it has proper articles, opinion pieces, fillers and clickbait. I read an article about esmorzaret by a bloke called Roberto Ruiz. Blog material I thought. Now I've actually seen esmorzaret, just once. I was a bit early for the guided visit I was doing to a citrus farm near Oliva, and I noticed the strange breakfast/brunch ritual of the locals. I did wonder if this was another very Valencian tradition, so I asked the same Pepa about this esmorzaret, and she came back to say that it was both trendy and traditional so much so that she and a group of friends were going out to get one the following weekend as a bit of an expedition as part of a group she's a member of "And after retirement; what?"

I need to add a bit of background here. Spaniards often reckon that they eat five times a day: desayuno/breakfast, almuerzo, comida/lunch, merienda, and cena/dinner. Whether the merienda is real or not, I'm not sure. British Victorians took tea at teatime, but teatime isn't that real for most Britons on most days anymore. Here though my concern is the distinction between breakfast and almuerzo. To overgeneralize, most Brits get up, shower, get dressed and eat something like toast, cereal or eggs—they have breakfast. Most Spaniards don't do that. They get up, have a breakfast drink like coffee or Nesquik, and go out to study or work. For the majority of the Spanish population their first substantial food is taken two to three hours after starting the day. They may go out to a bar or have a pack-up. If the office job starts at 9am and you eat two and a half hours later, it's probably going to be called almuerzo; if you started at 7am and eat at 9:30am, it's more likely to be called desayuno. The idea is the same. Sometimes an early lunch is called an almuerzo too.

Back at the newspaper article, the writer was waxing lyrical about the heritage of the esmorzaret which is basically a sandwich roll breakfast. Far superior, he said, to the foreign brunch and how the Valencian variety existed long before brunch was a twinkle in some foreigner's eye. How, for the food loving Valencianos, the esmorzaret is, not eating for the sake of eating, but rather a sacred custom that must be observed; a social ritual deeply rooted in the local culture, a ritual that has been passed down from generation to generation, from the labouring and peasant classes to having become a daily appointment for many Valencians today. But, the writer stressed, it's more than just a culinary tradition. It is also a time to disconnect, relax, and enjoy good food in good company. In fact, according to him, having a sarnie for breakfast is a fundamental part of the Valencian identity. One not to be overlooked if you are  a visitor and you really want to get to know the customs of this region. 

Roberto goes on to tell us that many people have their daily esmorzaret with their work colleagues, but it is the weekend lunches that are chosen to share the morning calmly with family and friends. Now isn't that a surprise? He says too that bars start to serve the esmorzaret from nine till mid morning. Here again we bump into a possible cultural difference. Morning in Spain lasts till you have lunch. So, for most people it's still morning till 2pm though I suspect that mid morning stretches no further than around 12:30pm.

The next three paragraphs are substantially his. I suspect he may get paid by the word.

For almuerzo, you don't go to a bar, order a sandwich, eat it, and leave. The esmorzaret goes much further. It starts with choosing the sandwich you'll have today, perhaps from a menu, perhaps a suggestion from the bar, or perhaps you choose the ingredients you want to put in the bread yourself by choosing them directly in front of a display case. Once the order is placed, you can then wait with a plate of cacau del collaret (peanuts) and another of olives, and in most places with a basic salad of lettuce, tomato, and onion. To drink? A beer, with or without alcohol, or wine, maybe pop.

Then comes the sandwich, the big moment. The variety is enormous, but some sandwiches never fail. The chivito is one of the best known, with chicken breast or pork loin, fried egg, bacon, ali oli (think garlic mayo), lettuce, tomato, and cheese. Also the brascada, with beef fillet, onion, and cured ham. Or the almussafes, with sobrasada (a paste made from ground pork seasoned with paprika), cheese, and caramelized onion. Or why not the ones with sausage, black pudding, and tomato; cuttlefish with ali oli; loin, pepper, fried egg, and chips; spanish tortilla de patatas with an infinite number of variations; or baby squid with ali oli. Practically anything you can fit between two layers of bread.

To finish, as tradition dictates, the best thing to do is to order a cremaet—a café solo with rum, lemon, sugar, and cinnamon, although the liqueur can be adapted according to taste. It is usually served flambéed and served aflame. All this, from when you started with the peanuts at the beginning to when you finish with the coffee, is the famous Valencian esmorzaret.

And back with Pepa she sent me a photo of the deserted Saturday morning tube station in Betera, where she now lives, to get in for a 10am esmorazet with her friends at Paiporta, a small town just South of Valencia city. Then she sent me pictures of the sandwich she chose, the accompanying chips and ali oli, the guindilla salad and the peanuts. 

El Mossett in Paiporta wasn't one of the ten recommended trendy spots to get your esmorazet in the article. If you're up there and you want to have a go then the mentioned spots were La Pascuala (El Cabanyal, Valencia), El Pastoret (Nàquera, Valencia), Va de Bo (Alfarp, Valencia), La Mesedora (Algemesí, Valencia), Nuevo Oslo (Valencia), El Racó de Vega (Xàtiva, Valencia), Kiosk La Pérgola (Valencia), Cremaet (Valencia), Mistela (Valencia) and Mesón Canela (Valencia)

 

PS It's also a "bank holiday", Hispanic Day, El Pilar, on 12th October but, as it's on a Saturday, and the shops, in the Valencian region can be open if they wish it will, probably, be a bit unremarkable.

Eat up your gruel

I wasn't going to do this again. Not for a while. In fact I have a very slight blog ready to go about ambulances, but a number of people have asked or sent me messages so, I'll do my best to make it short and sweet. Yet another update on me and throat cancer.

Nothing has changed in the treatment stakes. I've now done 25 of the 33 sessions of radiotherapy. An ambulance collects me from home and deposits me back here a few hours later. It can be as few as four hours from start to finish and as many as six and a half. The treatment takes about twenty minutes and the rest of it is waiting or travelling time and the occasional medical Q&A. Yesterday the ambulance from Alicante brought me home via Biar. Locals can gasp and chortle. 

I've done two of the three chemotherapy sessions. The third and, hopefully, final session is on Monday 14th provided that there is no medical reason for not going ahead - apparently things like anaemia, lack of platelets, reduced kidney function etc., can make the process unsafe which is why I have to get a blood test a few days before to check that I'm up to it.

This morning I got a bit of a pep talk from the nurse at the radiotherapy unit. She seems to be the person charged with keeping an eye on me. Her main concern is that I am losing weight. In fact my face had thinned out so much that the original "death mask" that they use to strap me to the table and to target the rays, was no longer up to the job. I had to have a new mask made and a new CAT scan done so they could pinpoint the tumours in relation to the new mask. We had a bit of a chat about this weight loss. As I pointed out I'm still hardly skinny - teetering on the boundary between overweight and obese using that Body Mass Index system. The nurse guffawed when I told her that. She checked. She seemed genuinely surprised when I was right. I explained, in Spanish, about the English word moobs. It didn't stop her though. She wants me to "eat" more. Now I haven't actually eaten anything since 19 September. Since then I have been connecting a squelchy plastic bag full of some all in one food supplement to the tube that comes out of my stomach. The bag is hung on high and it just drip, drip, drips into my stomach. the original plan was for three feeds a day, 600 calories a go. I've now been told to go for four feeds a day. It's a laborious process and the food stinks but I'll do what I can.

Actually saying the food stinks is something else. Cooking food, kitchen waste bins, the porridge residue in the plug hole etc., smell absolutely disgusting. Maggie tells me that things are no more smelly than normal though she says I have fetid breath. I'm not surprised. Nowadays I go to bed early, alone, in the guest room. I get to sleep easily enough but however long I stay asleep, till the first time I wake up, is usually the major part of the sleep I'm going to get. From there on in it's just tossing, turning and maybe a bit of snoozing. When I wake up, at say 3am, my mouth is lined with mixtures of phlegm, slime, and blood or snot tinted gobs of something horrible. Then again, someone has lined my mouth with sawdust. So I'm choking on dust and something as slimy as that Creature from the Black Lagoon at the same time. I can try to brush and mouthwash my mouth back into action but, if any of the liquids, including the "medical" mouthwash which, if it were sold in a standard size whisky bottle, would come in at 85€, touches the back of my throat I am wont to retch and throw up on the yellowy liquid I put into my stomach. It is a singularly unpleasant experience. 

The radiotherapy people are adamant that the majority of my problems are being caused by the whole body treatment which is chemotherapy. They accept that the radiotherapy has reddened my skin caused quite a lot of exfoliation but not much else. And that was the point of the pep talk from the nurse to tell me that with my only real complaints being my throat, a fair amount of throwing up with a bit of side grumbling about the ringing in my ears and how the lowering of my blood pressure makes me wobble, literally, from time to time, I was getting away with this almost consequence free so far. So, my lad, buck your ideas up and make sure you lose no more weight.

"Yes, Lourdes", was all of my reply.

Turning wine into water

I well remember our first ever fiesta in Culebrón. After the Saturday evening meal, under the pines, outside the social centre, the activity shifted to the paved square where there was a stage for the "orquesta," the showband so typical of Spanish small-town fiestas. As soon as we arrived at the square, I headed for the bar to beat the rush. There never was a rush; people went to the bar, but getting some booze down their necks didn't have the same urgency as it seems to have for us Britons. It's the same when a drink is finished; I, or we, go for another, but Spaniards don't worry too much about getting the next one in. They'll get around to it in a while.

I presume we Britons still say that Spaniards don't get drunk, or at least that it's very unusual to see them falling-down drunk. Point Britons at free or cheap booze and we will—at least I will—and I've always thought of myself as the person on the Clapham Omnibus, take advantage.

I used to comment to my Spanish learners of English, that the Spanish, on the whole, seemed to be more sober than we Britons and they would guffaw. They believed that the Spanish, as a nation, got drunk too. True, they had us down as a nation of beer swillers; multiple pints before falling-down drunk style, but they didn't see themselves as lightweights in the alcohol consumption stakes. To be honest I have no idea what it's like out there currently. Young people are the ones who tend to party, and as young Spaniards don't think of going out until late, by which time I'll be well tucked up in my bed, I'm not going to be there to see. Nonetheless, I've heard or read many recent articles that talk about the binge drinking habit of younger Spanish people.

On the roads the DGT, the Traffic Directorate, reckons that booze is present in more than 30% of road deaths and something like 25% are of those breath-tested after an accident are over the limit. Presumably that's one of the reasons that the government is considering dropping the limit from 0.5g/litre in blood levels to 0.2g/litre. That sort of limit means that if you drank a bottle of beer—a tercio (330 ml)—and you were an older man weighing between 75 and 90 kg, you'd probably fail the test unless you gave yourself an hour or more to digest the drink.

I've also noticed a lot of publicity around low-alcohol variants of booze and I've seen or heard several articles about how younger people are rejecting the alcohol culture around them—the culture that drinks beer or wine with a meal and starts a winter's day with a shot of brandy in or alongside your first coffee of the day.

If you live in Spain, you'll be aware of how common low-alcohol beers are. Non-alcoholic variants have about 13% of the Spanish beer market, whereas in the UK it's still well below 1%. There are actually two types of "non-alcohol" beers: 0,0 (zero-zero) and sin alcohol (without alcohol). The sin alcohol actually has a very small percentage of alcohol in it. If you get stopped by the Guardia for a breath test, you may well show as having alcohol on your breath even though you've been on sin alcohol all night. The zero zeros have no alcohol at all. Very few bars bother about the difference, but I've noticed that more and more often I get 0,0 when I ask for sin alcohol. One of the things I've always appreciated about low-alcohol beer is that it looks like beer. Once it's in the glass, those pains in the neck, who always want you to drink more, stop barking and shut up because they think you're on beer. It seems to me that this general principle is one reason for choosing newer non or low-alcohol drinks. Nowadays you can do something similar with a whole range of drinks, be that a 0º gin with tonic or a range of mocktails that are always there on menu lists alongside alcoholic ones. People who are temporary teetotallers (pregnant women, people under doctor's orders, drivers) have it much easier when they don't have to argue that "one won't harm you."

Low-alcohol beers have been around for years, but there seems to be a bit of a boom at present in other low and non-alcohol drinks which are typically alcohol-rich. Cruzcampo has been pushing a beer recently—Cruzcampo Tremenda—as "the perfect choice to enjoy a fresh and tasty beer without having to worry about the consequences." It has 2.4% alcohol, which is half the strength of their standard product. The other day Maggie bought some fizzy wine and it had a big 5% on the label; it was low-alcohol sparkling wine. In Villena, we asked for a tinto de verano in a bar, to demonstrate it to a couple of pals from the UK, and the version brought to our table was a low-alcohol one. True, it was a Colombian server and she seemed to have considerable trouble with my Spanish, but it helped persuade me that low-alcohol drinks are popping up everywhere.

So my general thesis is that for most of we older Britons the continuous, all day alcoholic happy hour, continues to be a part of our lives in Spain but the trend around us seems to be going for lower-alcohol versions. Maybe it's the start of a crusade against booze and very soon beer bottles will be carrying warnings just like packets of ciggies.

Something for the Palace Gates

My sister said that my nephew reads my blogs. He's just about to set off to Colorado because his new wife has a job there. So here's one to send him and her on their way.

Just for those who haven't been keeping up, I have throat cancer. The Spanish healthcare system is looking after me. However, because the Region of Valencia is being run by a very right-wing local government, one of the insidious little side effects seems to be that lots of patients are being passed for care in the private sector. I suppose they natter as they play golf together. Of course, I may be completely wrong. It may be because the private hospitals have more capacity or because they're doing lots of two-for-one offers.

The private hospital is for the radiotherapy. The thing where they strap me to a table and direct particle beams at the cancer in my throat and neck. The idea is that the rays damage the bad cancer cells but that my other cells are strong enough to fight back. Or at least that's how I visualise it. I could well be wrong.

The public hospital, the one in Elda, is where I talk to an oncologist who has decided on the treatment, and it's also where I have to go for three sessions of chemotherapy. Chemo involves using a drip to put some sort of poison into my veins. Again, I understand that the idea is that they kill bad and good cells alike, but the good cells can recover and the bad ones can't. I haven't Googled any of it. I'm just trying to do as I'm told.

The people in the radio place are perfectly nice, but the chemo people on the Day Hospital do their best to be incredibly "up". They say nice things to everyone. Very co-operative, odd sense of humour and very nice hair were my piropos for today.

I'm just an outpatient, I don't have to stay in hospital long. The chemo takes longer; it was about three hours today and four hours last time. The radiotherapy takes no time at all. For purely logistical reasons, I drove myself to Alicante this morning. I got there before 9 am and I was away to get to Elda before 10 am, and my underground parking ticket only cost 55 cents.

Normally an ambulance comes and gets me. For most of we patients, it's much more minibus than ambulance, with four seats in the back with space for a wheelchair and someone on a stretcher. There are the two seats in the front too. Sometimes it's a Magical Mystery tour with a pickup in Monóvar, Elda, Novelda, Monforte etc., and sometimes it's been a more or less straight run. Last week I had two trips that were more like taxi rides. One or no stops. Other times the journey can take two or three hours each way with lots of stops. I very seldom travel with the same people. I have to get up before six to be ready for the ambulance.

People who see me say I look well. That's because, so far, my hair hasn't fallen out and the skin hasn't stretched, leaving me with cadaverous sunken cheeks and a sallow complexion. My mouth is a total disaster area. It's lined with all sorts of foul-tasting mucus, and I often think I might throw up. I've given up eating by mouth simply because everything tastes disgusting. I drink water and tea (which tastes worse than the stuff they give you in bars) and then I drip feed some stuff like baby gruel or Complan into the tube that comes out of my stomach. My ears are very loud too, and I get tired even thinking about doing the weeding, but I'm still driving, still doing light jobs like cleaning the toilets, changing beds and doing laundry. Maggie, though, as well as the stress of my being ill, is taking an unfair share of the household work, particularly as I've stopped shopping and cooking as well as the garden.

So, I think that's it. The wedding plans are moving slowly as Maggie waits for documentation that will start the mad dash to get the rest. I'm still planning to book up one of the Imserso Pensioner's holidays tomorrow, and I have another blog nearly ready to go. It's taking a while because it's a bit weak. This one took the time to type it. Very fast.

The photo is from a local paper in 2020 but it is Elda

A quiet week

I was backing up the computer last week and there wasn't a single new photo to add to the photo album. This is distinctly odd. It means that I didn't go anywhere or do anything away from the daily routine. It's true my life is a bit off kilter at the moment and I wasn't much in the mood for galavanting but nothing? It also set me thinking about some of the things that we have done over the years

Tourism accounts for nearly 13% of the Spanish Gross Domestic Product—cars, the main Spanish export, account for about 10%, and agriculture just a tad under 9%. Tourism is becoming a problem in Spain, not really because of the tourists, but because of the people who make the most profit from them. In places like Barcelona, Mallorca, and Málaga, there is so much money to be made out of tourists that investment funds and the like have got in on the act. They buy up a block of flats to let out to tourists—if people have to be evicted in the process, so be it—because they make stacks more cash out of short-term lets to tourists than from the more traditional landlord-tenant relationship. So, whereas it used to be pretty simple for a couple setting up a new home to live in the same neighbourhood as their family and friends, they now find themselves unable to pay the inflated prices, and there is a general price hike all around as money chases the available rentals. Tourists have different spending profiles to residents. Trendy bars, vermuterías, bike hire shops, guided tours of the city, etc., aren't the first shops that locals need, just as the tourists are less likely to use butchers, pharmacies, and supermarkets. Traditional retail moves out along with the traditional residents as quickly as craft and local produce shops move in.

Obviously, the phenomenon of mass tourism overwhelming places is much more complex than a few nasty investors. Pop into a village on the Adriatic where three cruise ships of three thousand each pour 10,000 tourists onto the streets every second morning and see how it changes the face of the village. Up in the Pyrenees, we queued behind tens of motorhomes trying to negotiate streets that were too narrow and then sat among tourists in expensive-looking but spotlessly clean mountain gear, eating "traditional" ice cream. We were there too, though. We're a part of this.

Nonetheless, tourism is still something that lots and lots of town halls try to encourage. On one side, there are the places designed for tourists, like Benidorm, or places that attract tourists because they are loaded with things to see and do, like Seville and Madrid. But here, I'm thinking about the surrounding areas and how the decent tourist offices exploit what they have. It has to be said that most of Alicante province, or Murcia, isn't awash with lovely little villages or small towns enclosed by mediaeval walls. But tourist offices exist to promote what there is, what can be wrung out of the local environment. If what you have is the remains of the rail and steam-powered boom of the mid-19th century, or if it's Bronze Age remains and cave paintings, or a wine industry, or saffron packaging, or an architectural style, or a grape harvest, or a monumental cemetery, or a church, then that's what you have to work with. Some tourist offices are much better at coming up with something new than others but nearly all have their moments of genius.

We've got a lot of castles around here. If they weren't guarding the frontier between Christians and Muslims, they were guarding the frontiers between the old Kingdoms of Castile and Aragon. Often, where a town has something so obvious, they can either open the doors and hope someone turns up, or they can get on with a bit of promotion and arrange the dramatised visits, the reconstructions, and the jousts. I remember that in Sax, it was Juan Pacheco, Marquis of Villena, who tells you about his support, or not, for Juana la Beltraneja, whereas in Petrer, for a nighttime visit, the ghost of a murdered Moor told the story of the struggle for power in the city between Jews, Christians, and Muslims. Petrer also managed to weave the castle into its sessions about the end of the Spanish Republic in the 1930s.

Some towns don't have very much at all. The better tourist offices don't let that stop them, though. In Yecla, we've done a tour where each landmark—or where there had once been a landmark—had someone tell us the story of that place, accompanied by a musical performance. So, mediaeval music for the old church, and a bit further on, at the old gate to the town, we'd get North African music as a reminder of the Moorish conquest. We've done modernist architecture and the development of churches in Yecla, as well as tours by night. In Monóvar, we've gone on walks built around going out for a picnic as the locals did for years and getting a bit of history at the same time. With mention of Monóvar that leads to a couple of sessions based around the writer, Azorín, born in Monóvar, and schooled in Yecla. And while we're in Yecla, we went for a walk around their network of urban/rural paths and then went on an oil tasting session. They are only examples. The ingenuity is relentless. In Elda, we walked from spot to spot where someone dressed as a 16th-century peasant, a 19th-century shoe salesman, and a 20th-century nurse told us about the development of the shoe trade and the business community in Elda. In Novelda, the number of variations they can find on the theme of modernist architecture or their links to the seafaring scientist Jorge Juan seems endless. And while we're on Modernism, the week in Alcoy with half the town, and visitors, dressed up in Edwardian costumes and eating Edwardian snacks is really good fun.

There are also a lot of things that are based on activities. We've done any number of stargazing type tours—the culmination is counting the meteors or seeing Saturn's rings through the local astronomical society's telescopes - but it's also about perching you next to the Christ statue in Abanilla to explain the once Christian-Muslim divide, how the streets have twists and turns to give defensive positions and the construction of cave houses as much as to show off the 11-inch reflector. We've hunted for scorpions with ultraviolet light in the hills behind Elda, clambered up apparently vertical mountainsides to get to some Bronze Age cave site, and even planted trees.

Our very own town is a good example of this. Nice place that it is, Pinoso is hardly a tourist destination. The clock tower isn't exactly awe-inspiring, the Wine and Marble museum is nice enough but not exactly extensive, The Maxi Banegas route doesn't set the pulse racing and the recent travelling exhibitions in the Cultural Centre have all looked a bit dog-eared by the time they've got to us. Mind you, we've done some good stuff here. The tour of the cemetery around All Saints' Day, the tour of the local cucos, the dry stone-built rural shelters complete with dramatised episodes, the tour of the town's Civil War sites which was all done without seeing a single palpable trace, the tours of the town archives—all of them conjuring something from not very much. We've done walks with the town biologist, and we've seen rescued animals set free in the wild after they've recovered. Recently, Pinoso has started to explore food-based activities more because someone spent a lot of money on a show kitchen. Turning that into how to mix a good vermouth cocktail, how to cut ham, and any number of activities based on the local cuisine has been the upside to that.

The point is that with a bit of looking, there are any number of things to do alongside popping down to the coast, eating out, getting a drink with friends, watching the local fiesta or attending a local concert. 

So how're you doing?

I left the last blog when I had done two or three sessions of radiotherapy down in Alicante at the private Perpetuo Socorro hospital. The chemotherapy in Elda still hadn't started because I am, apparently, veinless, and they couldn't find a way to get their chemicals into my blood.

On Thursday of last week, they sorted that out by installing more permanent access to my bloodstream via a probe that leads to bigger, better veins in my chest. The same day, they spent four hours, first pumping saline into me, to make sure I was hydrated, and then pumping in some chemicals which, in my layman's understanding, are designed to be powerful enough to kill off nasty cancerous cells but not quite violent enough to kill me.

It's all a bit of a faff. Lots of the days have been exceptions for one reason or another, but the process is something like this.

I am scheduled for 33 sessions of radiotherapy. There is one session on each working day. I did number five today, so by my reckoning, that will take me through till mid-October. The radiotherapy directs X-rays, gamma rays, high-energy electrons, or heavy particles (and I have no idea which) at the specific area where the throat cancer is. I wait in a pleasant enough waiting area with free coffee and Kiss FM radio until they call me in. I take off my shirt, and they strap me onto a table with a mask over my face to help with targeting and to keep me from squirming around. It's not horrid but it's not something I'd choose to do for fun—not being a Tory MP. It doesn't hurt; there is no particular sensation of heat or anything, and it leaves no marks or redness. It takes fewer than twenty minutes from shirt off to shirt back on. I am told that from about the tenth session it will close up my throat, making it difficult for me to eat or drink, which is why, a couple of weeks ago now, they put a plastic tube directly into my stomach.

The chemo is done in a single session during the day. There's no overnight stay in Elda hospital. The place is a suite of recliner-type couches, a couple of big armchair-type chairs, and a couple of beds. Medics in purple pyjamas are here, there, and everywhere. They try to keep it all very jolly, all first names and a lot of laughing. Usually, people are given a bit of a choice as to which they prefer between bed, chair, or recliner, but the basic idea is that you get comfy, and then they hook you up to drips that first hydrate you and then do the poisoning of the cancer cells—different people get different concoctions. I think I have two more sessions to go, at least in the first phase. Next time around, I have to get a blood test a couple of days before they do the chemo session, and I think that also involves a consult with the oncologist.

So, neither of the actual treatments is particularly unpleasant, and both places are friendly and as un-grim as they can be. The problems come with what they do to you. And what the treatments do to people depends on what you're being assailed with and how you react. Currently, my effects are a very, very loud ringing in my ears, which makes me almost deaf in noisy situations. Most things taste very different and I've been unable to eat lots of stuff simply because it tastes horrid. My head aches most of the time, my mouth is lined with fuzzy felt, and there's a general feeling a bit like mild pins and needles throughout my entire body. My guts spend most of the time rumbling and gurgling, and I go from rushing to the toilet to wishing I could. I'm supposed to keep hydrated, which, apparently, means drinking water. Especially at night, that has a very unsettling effect on my bathroom habits and means that I'm not sleeping very well at all. The list of possible things to come—from skin eruptions to vomiting to total deafness—goes on for nearly 20 pages of A4. Going bald only gets a single phrase.

There are also a number of inconveniences. The port sticking out of my arm hurts a little all the time and has to be kept dry in the shower which makes for fun. I mentioned the feeding tube too. That still gives my guts an occasional twist so that I wince, but it's also a constant, unpleasant, presence. The feeding tube has to be redressed every day and washed through with clean water. At the moment I do that after I've showered. When my throat closes up, I will have to use that tube to eat. The method involves a squishy plastic bag loaded with some liquid-type mush which drips through the tube directly into my stomach. The feeding will take 45 minutes, and the tube will need to be cleaned and redressed after every feed. They also want me to push water through the tube twice a day. I reckon the feeding and dressing will take over three hours per day.

Combine that tube feeding with the ambulance. At the moment, an ambulance comes and collects me at 8 am every morning—a routine that has to be changed to get the blood sample done before a chemo session, and a routine that will have to be amended when the chemo is on the same day. Ringing the ambulance people is not one of my favourite tasks because it always gets complicated—an informal Spanish test. It takes me a while to get going in the morning as it is. When the time comes that I need to feed myself through the tube, I reckon I'm going to have to get up at 5 am every day to catch the ambulance, and it'll bring me home a bit before 2 pm. That's a lot of faff for a twenty-minute session.

So, so far, nothing terrible has really happened. I felt very sorry for myself over the weekend after the first chemo, but I seem to have bucked up today. I suppose too that even if everything goes to plan, if the treatments work, it's not going to be all over in a few months. There'll be tests and check-ups and procedures to remove ports and tubes and so on for months, and probably years, to come.

I'm not going to have many other experiences to blog about for quite a while, but people do keep asking.

And so it begins

So, we left the story with me in hospital, being fed on gruel and camomile tea, having had a stomach tube fitted. The hospital kicked me loose on Monday with only two scheduled appointments for the week at that time: one with a nutritionist and the other with a cancer doctor, an oncologist—both in Elda. Because not everyone has the advantage of living in Culebrón, I should say that our local health centre in Pinoso (5 km away) is linked to Elda Hospital (25 km away), but sometimes, for specialist services, patients are sent all over the place. The hospital I'm going to in Alicante for the radiotherapy, Perpetuo Socorro, is a private hospital about 55 km from home.

The nutritionist was a bit of a hoot. She gave us a box with 30 tubes to connect my stomach feeding tube to a pouch full of a Complan type food. That box was bulky but light. She also gave me a scrip for the feeding pouches, and the bloke in the chemist offered me a sack trolley to take those to the car. He also showed me how much they would have cost but for the health system—€768.

The next stop, with the oncologist in Elda, was make or break. She was subbing for my doctor, who's off on holiday. As she shuffled papers, when she wasn't quite sure what sort of cancer it was, etc., I rather cut across her and asked the one important question: has it spread? Is there metastásis/metastases? If the answer were yes, there would be no radiotherapy the following week; if the answer were yes, the €768 worth of sloppy food and the feeding tube were all a waste of time. If the answer were yes, then death was around the corner, and all the clinicians could do was to hold it back a bit. The answer was no. Relief a go go.

So now all that remained was to get started on the radiotherapy in Alicante and the chemotherapy in Elda. There were lots of criss-crossed phone calls, quite a lot of them taken as I drove across windswept Teruel Province in the car. The private hospital's appointments don't show up on the state system calendar that is used by the local health centre, the hospital in Elda, or the ambulance service, who I will be using to transport me up and down the road to Alicante. Appointments were made and unmade, but in the end, we had times for the radiotherapy, and when that was done, I was told to simply turn up in the chemotherapy unit at Alicante hospital, and they would get me started on intravenous chemicals when I arrived.

The radiotherapy was easy enough, at least the first time. They strapped me to the bed wearing a big fishnet design facemask, played soothing plinkety-plonk piano music backed up with tweeting birdsong while a big Space 1999 thing blasted me with Flash Gordon-type death rays. I didn't feel a thing. They have promised the pain for later.

I turned up at chemotherapy in Elda. We were instantly on first-name terms. They set about cabling me up and couldn't find a vein to get one of the needles in to direct the chemicals into my bloodstream. They tried with different people, people who do this every single day of their working week, and they tried five times without success. Eventually, two very pleasant blokes turned up with one of those ultrasound scanners—jelly on belly, ah, it's a boy—things. They're called ecografías here, so don't be surprised if I say eco. With that, they were able to see the veins in my arms and the needles as they were introduced. The veins collapsed the first twice, but it was third time lucky—or so they thought.

They hooked me up to some saline; again, I may say suero, but I didn't know. I thought it was the cancer-combating chemicals. My arm started to hurt; I was a bit surprised—drips are usually painless. After maybe twenty minutes, it was hurting a lot, and when I stroked my arm, I realised it was swollen. I'd sort of associated pain and nasty potions. In fact the vein had collapsed, and the saline was dribbling into my arm turning it into some sort of human sausage. A nurse squeezed some of it out, but six hours later sitting at the computer, there is still a steady drip of saline from my arm.

I'm going to have to reorganise the ambulances so that on Thursday I drive myself to Alicante for the radio and then on to Elda to get something called a Picc Port fitted, which is a sort of more permanent entry to plumb me into the drips. And that's where we rest.

____________________________________________

Just a couple of related things. Thank you to the tens and tens of people who have offered good wishes and practical help. I apologise for not always responding. The other thing is about the delay in seeing me. I have to say that I see nothing unreasonable about the delay outside the fact that the health service doesn't have enough capacity, probably because paying taxes is not a popular thing. I haven't come across lazy or indolent staff; I don't think anyone has screwed up or let me down anywhere. The initial referral took a long time, but I told the GP about a sore throat. She couldn't really refer everyone who went to her with a sore throat to a specialist every single time. The people who got to see the specialist in front of me presumably got there because their GPs saw something more urgent or because they'd waited their turn and got to the head of the queue as they should, as I did. I would be very unhappy if I were the queue jumper denying treatment to someone else.

Anyway, I'm well and truly on the treatment conveyor belt now, so fingers crossed and on to whatever the next thing is. Expect more blogs.

Paradores and dictators

For Maggie, my partner's, birthday this year we went for a weekend in the Parador in Sigüenza. A Parador is, basically, a posh hotel. Paradores de Turismo de España, is a state-owned commercial company, its sole shareholder being a government department. Paradores were originally conceived, in the first couple of decades of the last century, as a way of promoting tourism in areas that lacked adequate accommodation. The idea was to open up an area, particularly to well off tourists, with a particular eye on the developing motorist market. The first Parador was built in the Gredos Mountains from scratch, on a site chosen by the then King, Alfonso XIII. 

Soon after this first landmark opening some bright spark came up with the idea of converting unused large historic buildings to work as the hotels which would also help maintain the national heritage as well as being attractive to tourists. At the same time, another government committee began the construction of the new Albergues de Carretera. These roadside hostels had petrol pumps and workshops to effect running repairs on the cars and were located at key points on the road network. Seventeen were planned, twelve were built and most of them later ended up being turned into Paradores. One of them was the one at Puerto Lumbreras in Murcia. It closed about 10 years ago when Paradores built a new hotel in Lorca.

There are just short of 100 Paradores in Spain and lots of them are based on refurbished castles, like the one in Sigüenza, and monasteries. Others are architecturally impressive newer buildings and some are nothing particularly special, architecturally, except that they are sited in spectacular locations. The last time we'd stayed in a Parador, before this last weekend, was a couple of years ago when we stayed in Cuenca - in that case it's a converted monastery. 

We're not really well enough off to stay in Paradores very often, though they sometimes have really good low season offers, but every now and again, when we're feeling flush enough to splash out, we do eat in their restaurants. All the Paradores make a thing of promoting regional cuisine and all the restaurants are open to the public and not just to hotel guests. Indeed, in the past, they used to promote regional customs of all sorts and it wasn't at all unusual to be served a beer by someone dressed as an 18th Century kitchen maid or an early 20th century farmhand. Since the chain nearly went bust a few years ago they seem to have abandoned the fancy dress and gone for polo shirt type uniforms throughout their network. The bars are also open to the public so, if you're not looking for a room or a meal, you can still get yourself an overpriced coffee and take the opportunity to have a bit of a look around what are often imposing buildings. I have to be honest and say that sometimes we've been disappointed by the price and or quality of the rooms, food and even the bars but we keep going back because they are quite special places.

There is a, tenuous, link between the Parador chain and a Spanish dictator. It may not be the dictator you're thinking of. From 1939 to 1975 Francisco Franco ruled Spain. Franco managed to manoeuvre himself into the lead position among a group of generals who staged an uprising against the democratically elected government in 1936. The rebels expected to seize power quickly but instead the coup turned into a three year long bloody civil war. Between 1923 and 1930 there had been an earlier dictatorship in Spain. Just like in 1936 it was a group of army generals, this time led by Miguel Primo de Rivera, who thought that the politicians were making a pig's ear of running the country and so mounted a military coup. That coup was tacitly approved of by the King at the time, Alfonso XIII

From about 1927 Miguel became keen on spending on infrastructure projects and founding state monopolies such as Campsa, the forerunner to Repsol, the petrol and energy people, and Telefonica, later Movistar the telecoms company. One of the projects that he supported was the construction of the Parador hotels as a method of fomenting tourism and promoting a positive image, among the rich, about Spain. That's why the first Parador, the one in the Gredos, was opened at that time and on a spot chosen by the King. To push tenuous relationships even further there is a link between Miguel Primo de Rivera's lad, José Antonio Primo de Rivera, and the ideology of Franco's rule. Jose Antonio was the politician who founded the Falange Española which was a sort of Spanish version of the Italian and German fascist parties. He was killed in a jail in Alicante not long after the start of the Spanish Civil War but his party became the official state party of the Francoist regime and still exists.

Getting a shower

It turned out to be a bit of a porky. They told me I'd be in hospital for about 24 hours to fit a peg  - a stomach feeding tube. It's nothing more than a plastic tube that leads directly into my stomach. It will be needed when my throat has closed up so much with the radiotherapy that I can no longer eat through my mouth. In fact I'm here till Monday.

I thought this was the last of the pre-treatment things to be done before the real fun starts. I've been running around the province getting bloods done here, a talk to a dietician there and CAT scan at another place. The talk with the radiotherapy hospital in Alicante actually turned into quite a session. Information given, they made a sort of death mask (and I'm not being maudling, it's just what it reminded me of) by shaping a heated plastic mesh around the contours of my face. The idea is that I will be held in place by the mask as they blast me with rays and the grid, just like in a game of battleships, will allow them to direct their fire at the target. They also did a scan, with the mask in place, to locate my tumours against the grid.

Anyway I'm now wearing, rather fetching, Generalitat Valenciana pyjamas and sitting in my room along with my temporary bunkmate Stefan, who has hepatitis, in Elda Hospital. This is the third day I've been here and since the peg was put in I've been catching on to the everyday routines a little better.

That's why, daringly, I asked them if I could take a shower. The answer was of course but I hadn't anticipated the obstacles.

The first was that the peg has to be washed in the shower and that would mean I would have to apply new dressings, afterwards. I had no gauze, no tape. I asked. I got.

But I'd forgotten that the gauze needs to have a slit cut into it so I had to flag down a passing nurse anew. And, just as the nurse was about to go I remembered that I was tethered to a saline drip which meant I needed to be unhobbled. He disconnected me.

Finally ready to get soapy and damp and breakfast arrived. The instructions from on high have put me on a liquid diet. That is so the liquids can be injected into my stomach via the feeding tube but, at the moment, chowing down at a hog roast or eating fancy buns at the Savoy would cost me nothing but financial or digestive harm. The nurses and kitchen people said they'd see what they could do. I have to be honest  and say that after 43 hours of fasting being given a luke warm mint tea and a pineapple juice yesterday was just slightly disappointing.

It was camomile tea for breakfast.

Then back to the showering and apart from the minor flooding, the strangeness of washing around a plastic tube hanging from my stomach and trying to keep the dressing around the cannula dry it was fine.

XOXO

In the majority of Spanish bars, with most cold drinks, you will be given some sort of accompaniment. A few olives, a handful of nuts or a nut mix, a few crisps, maybe some panchitos (generic for cheesy puff, Monster Munch sort of crisp type things that aren't crisps) or even sugary sweets. You won't, generally, get anything with a coffee or tea, except maybe a biscuit. Obviously only the insane drink hot drinks with anything but bakery products. Some bars are more generous than others and some only serve the extras at given times. Something that used to be common, as an accompaniment, but aren't so much nowadays, are altramuces, lupin seeds. 

To digress, as I so often do, as I mentioned frutos secos (the nuts or nut mixes) I remember that they caused me problems when I was teaching English. To me it looked like a direct translation - dried fruits. So I'd go into a long spiel with the students about how the things that had a shell that had to be broken to get to the edible kernel inside - almonds, hazelnuts, peanuts, walnuts and so on - were called nuts in English while things like sultanas, prunes, raisins and the like were dried fruits. I could never understand why Spaniards were so slow to grasp the concept; in fact it was me. The Spaniards recognised the two different words - fruto and fruta - and I didn't. The first is the idea of produce or product and the second is fruit. So they were wondering why I was babbling on about why frutos secos - for nuts and the dry mixes - were different from frutas secas - dried fruit when exactly the same distinction is made in Spanish.

Back at altramuces, lupin seeds; they're shaped like large smarties or the flying saucer shaped M&Ms (and, if you're old enough, the all chocolate Treets of yesteryear). They get called chochos. Now chocho is a word used to describe a part of the body that (at least in the old two sex days) was specific to women. I've heard chichi too. Indeed someone asked Maggie if XOXO at the end of a greeting in a birthday card spelled chocho - I suppose the suggestion was that it was some sort of sex code. I quite like them, the plant seed snack that is. Spaniards generally separate the outer skin from the inner kernel. I can't be bothered and usually eat the whole lot. They're salty and a bit slimy. You can buy them in supermarkets in jars usually, stored in brine. They can be cooked but usually they're eaten cold alongside a drink as an aperitivo. Unlike edamame beans they are not, at all, trendy.