HEADLINES [click on headline to view story]:

Family Money

Personal Directions

The Doctor's Consultation by Dr. Iain Corness

Agony Column

Camera Class by Snapshot

Recipes from Rattana

Battling the Crab By Leslie Wright

A mother’s worst nightmare

Family Money: “Leaving on a jet plane...”

By Leslie Wright,
Managing director of Westminster Portfolio Services (Thailand) Ltd.

So you want to be a carefree expat.

Are you sure you’ve tidied up your UK tax situation? In common with many overseas tax authorities, the UK Inland Revenue assesses tax status and liability on a case-by-case basis according to general principles - and it can get complicated.

Regrettably, most offshore IFAs are not qualified to give expert tax advice to UK domiciles, let alone other nationalities! Some offer simplistic solutions - “Put it all into a trust” - which may be fine for some, impractical for others.

For instance, you can’t readily transfer real estate into a trust - and certainly not the villa in Ibiza or Phuket. This would have to be sold to a company first and the shares assigned to the trust - which may generate capital gains tax, not to mention complications with the bank if you’d mortgaged the property - not to mention the problems that might arise later if the heirs wanted to divide or sell the property, only to discover that Thailand doesn’t recognise offshore trusts, and an offshore company cannot own real estate (other than a condominium) in Thailand.

Unless your situation is very simple, and your UK holdings minimal, it is generally best to deal with the UK IRD through a professional tax adviser such as your UK accountant - who himself may have little idea how offshore investments or trusts work. You may well need more than one experienced professional to guide you through the ramifications.

In any case, the IRD should be informed in advance of your departure by completing form P85 to declare that you are going. (A range of guidance leaflets and forms may be downloaded from the IRD website, www.inlandrevenue.

If you’re away from UK for less than a full tax year (6th April to 5th April) you will remain liable to UK tax. To avoid tax on your foreign earnings and income, you must be non-resident in the UK for at least one complete UK tax year, as discussed in the IRD’s guidance leaflet IR20.

And no matter how long you remain non-resident, you’re still liable to tax on income derived in UK, such as property rentals, dividends, etc., which should be declared in an annual return.

Banking & Finance

Many expatriates arrange their financial affairs around two bank accounts. They have a local bank account to fund day-to-day living expenses in the country they are living in; and a secure offshore bank account in which to receive salary payments and in which to accumulate savings, or keep their cash reserve.

Since the introduction of international anti-money laundering regulations, you can no longer march into a country with a suitcase of cash - as many expat residents of Pattaya once did. If you transfer a significant sum of money into the country where you are going to live, for example to buy a property, this may have tax implications. Keep all records of the inward transfer and of what you then do with the money.

In Thailand, for instance, you can only get Central Bank of Thailand permission to transfer money out (except for trivial amounts) that had previously been remitted in - and to your own bank account (not the girlfriend’s.) Nowadays, your local bank may ask what any inbound remittance is for, and issue you with a Tor.Tor.3 certificate if the money’s going to be used to buy a condo, or a Tor.Tor.4 if it’s for other purposes.

Planning an Investment Strategy

Living as an expatriate can be an opportunity to build up wealth. However, not all the investment opportunities you encounter will be right for you. Never let greed blind prudence. A prudent investment strategy would be to start by building up a cash reserve in secure offshore high-interest accounts.

As you develop your expertise, you may become interested in other opportunities, including offshore funds investing in a range of markets and different types of asset. For many capital investors, buying units in funds through tax-efficient collective investment vehicles such as offshore insurance bonds is the simplest and most flexible way to go.

In any case, you should take professional advice before you commit your money to anything new. If you are reluctant to make your own investment decisions, one option is to use a specialist portfolio-management service.

Your UK Tax-Efficient Portfolio

If you have pre-existing ISAs (individual savings accounts), you may continue to hold them while you are non-resident for tax purposes, but you may not make further ISA investments until you resume UK residence.

You would be similarly ineligible to invest in most other UK tax-efficient investments while you are non-UK resident. For instance, you may not be able to keep up UK tax-efficient pension contributions while you are overseas.

Depending on the period you expect to remain offshore, it may be appropriate to invest in offshore savings plans - either open-ended or for a fixed term - to make up for this. But remember to discuss the long-term tax-efficiency of any such plan with your IFA before making any commitments.

UK Property

You can sell your UK property, or find tenants to rent it, or leave it empty. If you sell, you liquidate an asset that might otherwise be a worry. The proceeds can be reinvested in a flexible offshore tax-efficient vehicle which could be conservatively stanced for safety - for instance, an offshore insurance bond holding only money-market funds, with-profits, property and TEP funds, rather than higher-risk funds which could lose value in a market downturn.

If you rent out your existing UK property, you might use a property manager to find and manage tenants, collect rents, pay bills such as property insurance, and forward mail. One useful contact might be the Association of Residential Property Letting Agents (ARLA).

As mentioned earlier, you are liable to tax according to income tax rules on rents you receive from your property, which should be declared to the IRD. Full details of the Non-Resident Landlords scheme can be found on the IRD website.

It makes sense to insure your property adequately against the usual risks of fire, flood and theft, but also against tenant damage and vandalism - and this should be done before your departure.

Ensuring you’ve clarified and tidied up your tax situation will enable you to enjoy your life as an expatriate with one less worry.

Personal Directions: Taking time out

By Christina Dodd,
founder and managing director of Incorp Trining Associates

How long has it been since you had a really good holiday? One, two three years ... longer? How long has it been since you were able to be on your own for a whole day and do the things that you wanted to do, and not what everyone else wanted to do? How long has it been since you had time to yourself to just think without any distractions? Probably far too long is my guess. Time to ourselves - our own private time - is a very rare commodity indeed these days.

Personal quality time is something most people treasure but are unable to attain. Work and getting on with the daily chores in life take so much energy and effort it seems like the idea of finally being alone to pursue some of the things you enjoy doing moves further and further out of reach. I’m not meaning to sound selfish when I talk about personal quality time - I just think that it is an important aspect of our lives that needs to be fulfilled and not pushed aside and forgotten.

We need to take time out to reflect, review, rebuild, enquire and discover more about who we are and where we are going. We need time to indulge in the things that we like doing purely for our own gratification once in a while to remind us that we, too, exist and need to quench certain desires. But with all the distractions going on around us at our busy offices or in the home with the young ones, how can we achieve that? How can we take that so well deserved rest or break from the chaos?

The reality of it is that most of us don’t and we end up with increasing stress levels and declining states of health. Tempers flare, we get cranky and grouchy and are really not nice people to be around. We tend to complain and whinge more often than not and never give a kind word to anyone because we are so miserable with our own lot. Sounds like a pretty horrible place to be doesn’t it? Sadly, however, a lot of us live there.

Being pulled in several directions at once, juggling multiple priorities, lamenting about the difficulties of not having enough time to enjoy the pleasures of life, and handling all sorts of pressures and stress can lead to feelings of being totally overwhelmed, overworked and not appreciated by anyone.

One of the more rewarding sides of my training career has been my involvement in a series of programs that have enabled people to literally take time out and to review their own personal energy, to see where there’s a power outage, where a fuse has blown and begin the process of repairing the damage or putting preventative measures in place. This also includes looking at how we use our time and energy and how we might use those assets differently to achieve the results we want in a more relaxed, content way. Knowing what we need to operate at our own optimal level and being clear about what is important in our lives can enable us to make better choices about how and where to focus our energy and efforts.

In many ways we all need direction both in a professional and personal sense. Being all grown up doesn’t necessarily mean that we have all the answers and make no mistakes. We suffer as we grow into older adults, and the learning process is never over. We have to continue to devote some time to this process, and if we don’t, we are in trouble.

I recall a program I conducted in Singapore with a group of executives who had been highly stressed-out and were in great need of catching their breath and bringing their pace back to within sound and healthy limits. They were incredible achievers setting what they felt at the time were realistic and achievable targets. And not taking anything away from them - they performed brilliantly for the company. But not without a price to pay - their health - which also had a ripple effect on their professional skills which had an effect on the staff around them and so on.

Of all the activities and materials designed for the program which ran over a two day period, they seemed to give the greater response to those sessions which looked at the inner child and the building of relationships, moments of self assessment and reflection, times of sharing their deepest thoughts and desires. In terms of the inner child, they spent time pretending to be seven years old all over again, remembering the happiest times of their childhood and colouring in their dreams on large pieces of white paper with bright new crayons. It was a time to be peaceful and alone in their thoughts which was something these young executives had not been able to experience for a long time. They seemed to take on the characteristics of playful children in a playground.

They took to sharing their private thoughts and personal secrets with their partners in the training, like ducks take to water. After this experience it was almost as if a great burden had suddenly been lifted and they were able to discard a lot of emotional baggage that had been creating problems and causing anguish in their lives. Finally, at the end of the program, they were then ready to move forward with a deeper understanding and awareness of themselves and of what was most important in their lives.

Finding focus and having the time to devote to doing this proved to be a very worthwhile experience for this group of young people. It was an investment well spent and allowed those executives to maintain their positions and to go from strength to strength. Of course this kind of program has become an integral part of the company’s training schedule and is considered a vital safety valve in what the management regard as a pressure-cooker industry. But I believe that all fields of industry need to take a closer look at the people that they employ and their particular professional and personal needs. It’s always wise to practice a bit of preventative medicine rather than having to find a cure.

Humans are extremely resilient and have strong instincts for survival. They fight back and bounce back in extraordinary circumstances. But despite this, they need to be constantly reassured and accepted. They need to be regarded as important and require certain levels of attention that some times we overlook. In the workplace it is crucial that employees are treated this way. This does not mean pampering to their needs without thought and due consideration. It does mean realizing that every employee is an individual first and foremost, and through building on their existing qualities and strengths and improving upon their personal and interpersonal skills, they will become better equipped to perform in their roles as managers and leaders, presenters and communicators, team builders and team players.

I am continually surprised by the ability of people. Some have a natural talent or gift to excel and some require coaching and guidance. But at the end of the day, everyone has their own unique attributes and strengths that drive them forward. To take time out to “top up the tank” or to “give more flavour to the stock” is such a small price to pay when we look at the possibilities that lay ahead and what can be achieved.

Until next time, have a great week!

Should you require our assistance in providing some quality “time out” for staff at your company or organization, please don’t hesitate to email me at christina.dodd or contact me at Incorp Training Associates in Bangkok.

The Doctor's Consultation by Dr. Iain Corness: Have you got piles? And I don’t mean money!

Piles are one of the most common ailments around. Embarrassing and often a pain in the bottom, to coin a very apt phrase! The medical term for Piles is Haemorrhoids, which shows why we don’t commonly use that name - too long and too hard to spell! I have often said that the reason that the medical course is 6 years is that it takes 5 years to learn how to spell the long words, but then, I’m joking of course.

So just what are piles and do you get them from sitting on wet grass? Let’s deal with the grass first. You do not get Piles from sitting on anything, be it grass, newly mown or otherwise. End of the grass story. Piles are simply ‘varicose veins’ of the anus. You see, around the edge of the anus there is a very rich plexus of arteries and veins and it is possible for the veins to become distended and eventually form a grape-like structure that can even protrude from the anus itself. A classical “Pile”.

The biggest problem with Haemorrhoids is acute bleeding. Embarrassing as mentioned before, but can actually be such as to run you out of iron and you end up anaemic. Other symptoms include local soiling, discomfort and prolapse. You can also get a thrombosis in one of these protruding piles that can be very painful indeed. Ask anyone who has ever had one (or two).

There are lots of theories as to why we get haemorrhoids. Many women feel that they are the result of pregnancy or straining during childbirth, but since men get them as well that would appear to shoot that theory down in flames. A lack of dietary fibre has also been given the nod as a cause, but personally I am not convinced, as many people with great fibre diets still get Piles. Constipation and straining at toilet does appear to have a bearing, but I honestly feel that the real reason relates very simply to our stage of development in the history of mankind.

My theory (Darwinian, I admit) is as follows - we used to walk on all fours, like all the other quadrupeds. Look at our first cousins, the monkeys, and they are still wandering around with knuckles in the dirt, but many moons ago after seeing our reflections, we decided we looked better standing on our hind legs, so we learned to walk erect. This was fine, other than the fact that the valves in the veins in our legs and ano-rectal region were not up to the additional pressure the column of blood was exerting from the heart, now a metre or so higher than the valves. Straight out hydrodynamics.

Fortunately Piles are relatively easy to fix, and the common rubber-banding technique will be successful for most. The only real danger in this condition is in ignoring the bleeding, thinking, “It’s only piles.” As mentioned before, this bleeding can lead to anaemia, but the biggest problem can be the fact that rectal bleeding might just be a symptom of cancer, and not haemorrhoids, and it is possible to have both complaints.

The answer is to never ignore bleeding (from any cause) and get your doctor to check. It may be embarrassing - but it could be life saving.

Agony Column

Dear Hillary,

Recently I was walking to my favourite bar when the skies opened up. I was ducking in and out of doorways trying to dodge the rain. Outside a tailor shop my wet shoes slid on the shop’s ceramic tiles and I totally lost my balance. I reached out and grabbed hold of a portable rack of neckties in an attempt to steady myself, but I crashed onto the tiles with a pile of gaudy coloured neckties falling on top of me. I must have hit my head because for a moment I didn’t know if I was in Thailand, tile land or tie land. The tailor came out of the shop gesturing wildly with his hands and shouting at me in his native tongue. Why can’t shop owners use non slip tiles in their premises, am I under any obligation to wash or pay for all those ties that are now just a soggy mess, and where in Pattaya can I learn the Indian language so that I can interpret what the tailor was yelling at me?

Mighty Mouse

Dear MM,

You certainly do seem to bring trouble on yourself, don’t you, Petal. Now you are getting tied up with Indians and wondering if you should learn another foreign language and cement more ethnic ties, or was that get the ethnic cement off the ties? The first aspect of this problem is tied in with where you were walking. You should know by now that footpaths outside tailor shops are for displaying gaudy shirts, wind cheaters which say JAG - UAR or FER - RARI and the aforementioned racks full of ties. They are not for walking on, and even if it is raining that is no excuse. Now as far as your problem with getting tongue-tied when discussing family ties with Indian tailors, this is not a huge setback, as they all speak Thai. So try Thai regarding the tie. There you are Petal, I’ve really tried for you this time!

Dear Hillary,

I am getting married in a couple of weeks to a wonderful Thai girl who has never given me any problems like all the ones I read about in your column Hillary. However, the other day she asked if I minded if some of the people from her village called in to see her, so I just said OK, but when I got home there was about two dozen of them all over the house, in front of the TV, lying on the settees, sitting on the steps and drinking beer. If they had said excuse me or something like that I would not have been so annoyed, but they stayed there for two days before they went back. Every night I had to pick my way through all the bodies. I really cracked up in the end and they left. Now my girlfriend is sulking and she is giving me a hard time, because I raised my voice in the house. Do you think I was being unfair, Hillary? Or is my girlfriend being unreasonable? I think I really have to clear this up before the wedding, so can you answer quickly. If it costs some money for a quick reply that’s OK too.

The Groom

Dear Groom,

Costs some money? Costs some money? How dare you, young man! I will have you know that there is complete transparency in all of Hillary’s dealings. Money? I do this column as a service to the readers, not as a way of gaining income. (Anyway, the old skinflint’s salary he gives me wouldn’t even keep me in one box of chocolates and a bottle of beer a month, let alone champagne! Not that I am hinting, mind you!) So back to your pre-event problems. All sounds a bit like Groom’s Fairy Tales to me. Are you sure you are not suffering from cold feet? It is quite normal, you know. You should also have known by now that this is normal behaviour in Thai families, and that is what you are joining. You live in Thailand, you are contemplating marrying a Thai and you will be responsible for all of the family’s needs, be that feed, water or money, or even medicine for the buffalo. This is expected, as well as showing that you have ‘jai yen yen’ (a ‘cool’ heart). Your fianc้e is upset that you have not shown jai yen yen, even more than she is upset at your not welcoming her village people. I think you have to groom yourself a little more before becoming the groom, Mr. Groom.

Dear Hillary,

I have noticed that you are always telling the foreigners who write in that they should learn the Thai language. Does that include the writing as well? I wonder if this is really all that necessary, as in all the bars I go to the girls speak English and in hotels it is easy to find people who speak English, don’t you agree?

English Ernie

Dear EE,

Try driving around up-country and reading the (Thai only) road signs if you don’t think it is important to read Thai. As far as speaking the language is concerned, wait till you are fluent and you will find out what the girls in the bars really think of you after the usual welcome, “Sexy man, sit down please!”

Camera Class: Phame as a Photographer!

by Snapshot

Any camera owner who has ever read any photo books or magazines will have heard of famous photographers who are still remembered for their art. Names like Ansel Adams, Henri Cartier-Bresson, Irving Penn, David Bailey and Joel Myerowitz spring to mind, but you can add David Hume Kennerly to that list. Now I must admit I did not know of this chap (who is still very much alive, by the way) until my photographic friend Ernie Kuehnelt brought him to my attention.

Photo by Henri Cartier-Bresson

Turns out that Kennerly is a Pulitzer Prize winning photojournalist who has covered 8 presidential campaigns in the US and shot 35 covers for Time and Newsweek, which are 35 more than you or me. However, what brought him to the fore was a project he did in the year 2000. His goal was to record world life and culture, especially in America that year. To do this he travelled across 38 states and 7 countries, taking black and white photographs. One a day!

The diverse shots, and they are truly diverse, from shots of his sons looking at his broken leg, to a vacant parking lot in South Carolina, have been put together into a show which is on display in the celebrated Smithsonian Institute in Washington until December 29th this year (you can still get there if you hurry).

Now the article this week is not to get you to book a flight to the US of A, but is to show you that by having a project you can produce a body of work that can become an important work of art and even make you famous.

If you don’t believe me, try this. A lady decided that on her birthday she would have a photo of herself taken in the nude. She was in her early 20’s from memory, and now, 30 years later, she is still doing this project. Every birthday, a birthday suit picture! Medical science got to hear of this and it turns out that this is the only existing record of personal aging in the world, to span such a distance in time. We all have photos from our teens over which we wince when we see them and compare them to how we look now, 10, 20, 30, 40 years later or whatever. But do you have the intervening shots? And one a year, catalogued? Of course you don’t.

So what can you do to get yourself into the annals of photographic history? The answer for the average photographer has to be a progression of some type. This photographic work stands on the fact that you are recording something happening over a period of time. It is not a body of work that exists because of its great photographic technique.

Now some of these have been done before, but here are a few ideas to get you started. Record a flower opening and closing - one shot every hour during the daylight. Place them side by side, in order from the left, and you have just made a photographic statement. (By the way, it must be from the left, because we read from left to right, unless you are into some Arabic or Chinese writings.)

Did you ever see the film “A Zed and Two Noughts”? In it they recorded, by serial photography, the decomposition of once living tissue, dogs, cats, etc. The finale was the “stars” arranging time-lapse photography of their own demises. You could extend your flower shots to include the birth and death of the flower. Again, this would be an interesting piece of work that would really tell a story.

So can you see where I am headed? A temple from dawn to dusk, a mountain taken every day for a week, a baby every day for a year. The subjects are only limited by your imagination. Let it work over time and give you a photo project to work on. You never know, you could end up being exhibited in the Smithsonian Institute.

Recipes from Rattana: Chicken Fried Rice (Khao Pad Gai)

This is a real Thai standard that can be had at any restaurant or roadside eatery. You can substitute pork for the chicken, or even shrimps or crab, or a combination. This is a great recipe to use up what is left in the refrigerator! The cooked rice should be yesterday’s as well!

Ingredients Serves 2

Chicken breast pieces 1/2 cup

Vegetable oil 2 tbspns

Tomato, thinly sliced 1

Soy sauce 2 tspns

Ground pepper (prik Thai) 1 pinch

Fish sauce 2 tspns

Egg 1

Pre-cooked rice 1 cup

Onion, chopped 1/2

Garlic, minced 2 cloves

Medium red chilli sliced 2

Cooking Method

Heat the wok with the oil until it is very hot (smoking) and very quickly stir-fry the chicken. Push the chicken to one side of the wok and crack the egg into the pan and quickly scramble, chop into small pieces and then place to one side with the chicken. Add the day old cooked rice and all the other ingredients and mix them all together with the chicken, egg and rice. Stir fry, mixing all the time for two minutes and sprinkle with ground white pepper.

Serve with sliced cucumber and two wedges of lime.

Battling the Crab By Leslie Wright: Part 5 of a 6-part series about fighting cancer

Side effects

In my case, I had been prescribed a cocktail of four chemotherapy drugs, which were each administered over a three-day period, together with significant amounts of intravenous saline solution to flush the chemicals through the body. Obviously one has to be a hospital in-patient for this; and in my case, the regime called for six sessions, about 3~4 weeks apart.

As things turned out, I was again one of the fortunate ones who suffered relatively few side effects. Some people feel constantly nauseous and cannot keep any food down; I was relatively unaffected in this regard - but it’s wise to stick to bland food.

The first week after each round of in-patient chemotherapy I felt more or less okay, but the effects generally hit in the second week. Indeed the oncologist recommended I take convalescent leave during this period. I would ache all over and feel like I had had a bad dose of flu. There were days when I could hardly crawl from the bed to the bathroom. I’d have little appetite. I’d constantly develop gas in my stomach, which soda water helped a lot to relieve. I’d be constipated for days on end, despite taking laxatives prescribed for this expected side effect. Not pleasant, but many people have it far worse than I did.

The chemotherapy also significantly affected my white blood count (WBC), lowering it to near-danger level. I was advised to be very careful to eat only cooked foods - steamed or boiled, not fried; and no raw foods like lettuce, and to peel fruit, since germs on the skin and surfaces could do me real harm whilst my immune system was in a weakened state.

The third week I’d start to feel better, and if my WBC was up above the critical level, we’d schedule the next round of chemotherapy. Otherwise, we’d postpone it for a week.

While white blood cells last only a few days, and are quickly regenerated by the body, red blood cells last about three months, and are not so quickly regenerated. As the months passed my red blood count (RBC) was also slowly dropping, to the point where at month 4 of treatment I was having to inject myself every third day with a drug to stimulate red blood cell production. (And this drug was expensive: Bt.4,900 per one-time syringe!)

The after-effects of the third round of chemotherapy were probably the worst, and by the sixth round I was feeling significantly better.

Of course, in the initial period I was undergoing daily radiation therapy (which involved travelling up to Bangkok and back to Pattaya every day, 5 days a week - a tiring journey at the best of times) as well as chemotherapy, so it is not really surprising that my strength should have suffered during this period.

After the first round of 24 radiation treatments, we then scheduled another round of 12 treatments, focussing on the other vertebra which on the MRI-scan had showed signs that it might have a cancerous lesion. (It wasn’t definite, and the only way to have been sure would be to do a bone biopsy, which is invasive and apparently very painful, so we elected to go ahead with the radiation therapy - just in case.)

After the tests at the end of round 6 of chemotherapy showed that I was effectively in remission, my radiologist recommended that I should undergo a further round of 20 prophylactic radiation treatments on my brain.

The reason for this is simply that while the chemotherapy drugs will have penetrated all the organs of the body and hopefully killed any microscopic lesions that may have been developing elsewhere than the main tumour site, the chemotherapy drugs do not cross the blood/brain barrier, so will not have ‘cleansed’ the brain. And 30% of small-cell carcinoma patients develop lesions in the brain. And these can lead to blindness and/or deafness and/or dumbness and/or short-term memory loss and/or long-term memory loss and/or paralysis and/or death, depending on where they are located. Not a pleasant prospect, and one which I’d rather avoid if possible. So it seemed a good idea to proceed with the prophylactic (preventative) radiation treatments, which meant once again travelling back & forth to Bangkok every day for the whole month of June.

I had been warned that one of the side effects of the radiation would be total hair loss - my hair, after turning completely white within one month of the initial diagnosis, but never falling out completely, had actually started to grow back and regain some colour. But as I write this I have only about 24 wispy strands left - but it’s fashionable these days to be bald, and as my radiologist pointed out, I save money on shampoo.

Another of the side effects would be my face turning red, like a bad sunburn. I was not told that my skin would also dry up and itch constantly - and the temptation to scratch has to be resisted, because one would inadvertently break the skin and end up with unsightly scabs.

Having one’s brain ‘fried’ causes it to swell, which results in headaches; fatigue is another side effect, but paradoxically, although I felt constantly tired, I couldn’t sleep properly. That started back around month 2 of chemotherapy, and my oncologist had prescribed some mild sedatives to help in this regard.

(To be concluded next week)

A mother’s worst nightmare Part 5

By Lesley Warner

The following morning she left to book into the hospital in quite a nervous state worried about the first of the operations. She said she didn’t want to be put to sleep again. The operation was on the Monday for 4-5 hours so we knew that we couldn’t see her, the surgeon had already said that her injuries were complicated and that was why there were several different doctors, specialising in different fields, involved in her case.

They planned to take skin from the buttock for the shoulder and hand, and skin from the good eye for the bad eye. When we arrived we didn’t really know what to expect and she looked very uncomfortable with a cast on her right hand and arm, in a sling hanging from a drip stand. There was a dressing on her eye and she was wriggling around with a sore backside and neck. It turned out that there was not enough skin on the good eye so they took it from her neck the results were excellent. She had looked skeletal before having no flesh beside the eye; the surgeon had built it up and remade the eyelid.

When I questioned the fact that they had not mended her bones and only patched the hole in the shoulder, they said it was because the orthopaedic surgeon was not available and the shoulder needed a metal plate, pinning and possibly muscle from the chest wall. They were unsure of whether it was a muscle or nerve problem. I asked when they would fix the shoulder and I was told vaguely when the graft was healed; maybe 6 weeks, bearing in mind we were already into the 6th week after the accident.

At this point I was losing patience and understood the horror tales of the NHS. I said to the doctor, “In case you hadn’t noticed there is a perfectly good hand on the end of that arm.” He answered, “Yes I see your point.” I then said, “What about the bone broken in her wrist on the bad hand?” I could tell the doctor didn’t know she had a bone broken between the wrist and thumb. He obviously hadn’t read her medical notes.

The middle finger was wired but would be no use because of infection and the index finger is indescribable having no bone above the knuckle, at least they cut off the top of the thumb and grafted a new bit. The doctor said they will do more work with them but Emma decided against amputation in case there are other options available in the future.

Eventually when they removed the cast after a week they had to put a special plastic mould around the wrist to prevent more damage to the thumb, and then decided that she should have been wearing a sling for 6 weeks to prevent the movement in the bad shoulder. The arm was now hanging on the front of her body and the wound had moved from the front to the back.

I asked Emma how she felt about her friend who was driving, and she answered, “How would you feel about your best friend? She doesn’t stop being my friend just because she was driving. She didn’t do it on purpose did she?” I can’t feel the same and cannot bring myself to talk to the girl and neither can Emma’s husband, but maybe it’s different from our side, we were the one’s that nearly lost her.

Now she just has to wait and see what improvements will be made from the future operations, but she has great healing powers and an enviable determination. It’s difficult to explain, I suppose I thought she would be different but she’s not, she’s still my beautiful Emma.