The Dangers of Laughing gas

I used to work in a highly specialised, controlled environment designed to manufacture semiconductor devices and integrated circuits on the tenth floor of the Ashby Building at Queen’s University Belfast. It was a clean laboratory where continuous filtration achieved 99.99% efficiency in removing even the smallest particles.

The air we breathe is a precise mixture of gases:

Nitrogen 78%, Oxygen 21%, Argon and trace gases 1%, and Carbon dioxide 0.04%.

On one occasion, an alarm sounded to warn that oxygen levels in the lab had risen too high, and we were instructed to evacuate until they returned to normal. It served as a powerful reminder of how vital—and how finely balanced—this mixture is for life. Disturbing it, even slightly, can have serious consequences.  So imagine my surprise when, this morning, I found something quite different on the doorstep of my apartment block, left out with the usual rubbish for collection.

There were around six blue canisters labelled Miami Magic—nitrous oxide. While commonly used for whipping cream, it is increasingly misused by young people for recreational purposes. I doubted anyone needed to whip that much cream and wondered who was using this substance here in Malta.

Nitrous oxide is now considered the third most commonly used drug among 16–24-year-olds in the UK, after cannabis and cocaine. Other surveys suggest that between 10% and 20% of teenagers and young adults in some European regions have tried it at least once. A global survey in 2021 estimated that nearly 24% of people aged 16–24 had used it. In the United States, poison centres recorded a 1,332% increase in annual cases of nitrous oxide poisoning over a 20-year period, with a particularly sharp rise from around 2023.

How it is used recreationally

Typically, the gas is released from the canister into a balloon—direct inhalation from the canister is dangerous due to the pressure and extreme cold. The user then inhales the gas from the balloon to experience its effects. In some places, young people pay around five euros for two balloons. As always, where there is demand, there are those willing to profit from it. Recent local reports have highlighted the growing use of this gas among young people in Gozo.

The Effects

Often called “laughing gas,” the effects are almost immediate but short-lived, lasting only a minute or two. They include light-headedness, euphoria, giggling, and altered perception. Because the effect is so brief, users often repeat the process multiple times in a session, increasing the risks. The name itself tends to downplay the seriousness of the substance.

Immediate risks

Nitrous oxide reduces oxygen availability in the body, which can lead to fainting, loss of consciousness, or, in extreme cases, death. The gas is stored under pressure and expands rapidly, which can cause cold burns—freezing the skin, lips, or throat if inhaled improperly. It can also affect heart and breathing function, particularly when combined with alcohol or other drugs.

With repeated or heavy use

Nitrous oxide interferes with vitamin B12, leading to deficiency. This can cause nerve damage, resulting in numbness, tingling, weakness, and difficulty walking. In severe cases, it may lead to long-term damage to the spinal cord or brain. Mental health may also be affected, with symptoms such as mood changes, confusion, and cognitive impairment. Some studies indicate that damage can develop within weeks or months of repeated use.

In response to these risks, governments are increasingly taking action. Malta has now officially banned the recreational use of nitrous oxide as of Wednesday, 29 April 2026. It is hoped that this measure will help reduce its use and prevent the harm it can cause—particularly among the young.

The Snot Factory

I have been ill for four or five days, but the long nights of retching coughs that burn the muscles in my chest make it feel much longer. The snot factory has gone into overdrive. My body fights a perennial battle between the need for sleep and the overarching necessity for breath. When I rise, coughing and spluttering, it is because my lungs are drowning in this excessive production of mucus.

For the first time in my life, I have lost all appetite. This is worrisome. I never stop eating. Miserable, happy, distraught, or beyond grief — my appetite has always been faithful. But not this time. I cannot face coffee or tea and force myself to sip water like medicine. Our vital organs, after all, require at least some liquid.

I felt the faint flicker of recovery yesterday and managed breakfast: tea and toast. However, last night brought a full return to snot production, and I, like a long-distance swimmer, lifted my head for coughs and then for air.

It is a strange business, this being unwell. I never understood the expression weary unto death, but I think I do now. I’ve learned a great deal these past five days and nights, and for those who wrestle with pain and discomfort year after year — what can I say? I drop to one knee in homage to your resilience and strength. None of us knows the loads carried by others, the dangerous paths they are forced to tread. 

To judge is, indeed, a flawed act. Even this bloody snot factory has taught me something.

Lessons learned in a dark A&E

Heartbroken by the rows of trolleys packed back to back in corridors at 2 am in a darkened A&E department. Most seem to hold an elderly patient grey-faced and loosely bandaged in a twisted blanket embalming the old and sick. Heads hang off necks too weak to support them. The trolleys are bereft of pillows with cold and plastic surfaces easier to wipe down and clean. Their inhabitants, if strong enough, repeatedly plead for pillows to any passing staff member. Pillows are banned now along with much of the expected humanity one would hope to find in a place of healing. 

They usually only end up here as a last desperate resort. When really in pain beyond endurance or unable to draw breathe properly, the elderly, like my mum at 89, break their daily vow never to go to hospital, and 999 is dialled. Mum’s ambulance had raced from Limavady to Ballymoney to collect her as Coleraine Hospital had all their available ambulances parked outside A&E unable to offload patients.   My Mum was shaking uncontrollably for hours with severe back pain, vomiting, and breathing fast shallow gasps of air until we eventually called the emergency services. 

The ambulance arrived in response to the call in just over half an hour and the dispatcher stayed on the call talking to me while we waited.  A team of three determined ambulance personnel arrived with loads of equipment and quickly checked measured blood and heart measurements. They administered pain relief and insisted on taking my mum to the hospital. They said there were just too many worrisome medical indicators and we reluctantly agreed. They decided to go to Antrim hospital because of the queues outside Coleraine A&E.  But when we arrived outside Antrim A&E there was a five-hour wait in the car park. My poor 89-year-old mother gasped in agony at the hardness of the stretcher in the back of the ambulance. The wait seemed never-ending, those trolleys are not designed for comfort. During that long and unbearable night, I was struck that so many elderly and vulnerable patients are lying for hours and hours waiting for help in such conditions. Some die on these hard-cold trolleys outside hospitals and it seems to go on getting worse and worse instead of being improved. We wouldn’t let a badly injured dog howling in pain sit in the back of the van outside a vet’s so why do we expect the vulnerable, the ill, and stoic elderly to endure such conditions?  

Shame on this system of abuse. Is it due to a lack of funding, gross incompetence, a lack of staff, shortage of beds or equipment, staff burnout, or GPs hiding in the trenches while emergency services face all the flack?  I have no idea, what is wrong with the system. I cannot fault the kind ambulance staff or the over-pressured hospital staff but it is not acceptable. Too many are in corridors or in the back of ambulance vans suffering pain and whatever we are doing is not fixing it. On my worst days, I wonder how truly awful everything will have to get before we throw off this strange stupor and make even small changes to improve these conditions. I know there are amazing souls working their hearts out to try and make a difference it’s just I just feel we need to do more than just applaud them.

When we had eventually entered A&E mum’s trolley was wheeled into a corridor filled with other patients on trolleys end to end like carriages of a train awaiting a missing engine.  In the nearby ward, there is a shouting angry man and there seems to be three staff remonstrating with him.  I think they want him to wear an oxygen mask but he doesn’t want it and shouts violently and aggressively, he pulls it off and the staff tries to reconnect it.  Their arguments go on hour after hour and there is a tiny part of me rather ashamed to resent that this nosy intoxicated patient is draining all the efforts of so many staff.  After all, the softly moaning old lady two trolleys away may need more help but is not getting much attention.  Another patient in the ward is a young teenager who has tried to commit suicide and two staff try to convince her to stay rather than discharge herself immediately.  Her father arrives and joins the team pleading that the results from blood tests need to be checked before she can leave.  She is dressed and standing close to the ward door trying to push past them as they valiantly encourage her to stay.  This discussion lasted a good 40 minutes and was conducted with a lot of shouting.  It seems that, like in most places, those that have the energy to protest louder get a lot more attention.  Even here in this world of sickness and pain, it is the noisy demanding patients that drain valuable resources their way.  The very ill and old have little energy or will to make such demands and just endure the lack of attention, the noise, and the disturbance.  

I stayed by my Mum all night, beside her trolley, on a plastic chair kindly provided by a night nurse.  In the early hours of the morning, I could rub her sore back, and whisper answers to her questions.  In this frightening and foreign place, we had each other.  My Mum hates hospitals and on the rare occasions, she has had to go in refuses to eat or drink and seems to withdraw into herself not speaking to staff.  She can lose so much of her body weight in days.  When the morning shift arrived, I was told to leave the A&E immediately.  

Perhaps if the health system all had looked efficient and professional I would have accepted this better.  But in the chaos of so many patients and shortage of staff, I felt that I was being asked to desert a loved one to uncertain unsteady hands.  I was told they would do some tests on my Mum and I needed to leave but when they finished the tests they no longer allowed me to enter the A&E.  I remonstrated with staff to no avail and waited in a closed hospital café restless like a dog that has left its post.  A nice passing nurse, from a different department, let me back in with her card and I found mum had been moved to a different alcove, she seemed more withdrawn and silent.  The nurse in charge found me back in her A&E and was understandably annoyed and insisted I leave immediately.  I am ashamed to say after an hour or so outside I followed a passing cleaner into A&E who kindly let me in behind her.  This time the head nurse was angrier to find me back again beside my Mum.  I felt like a loyal dog that was being chased from the side of its owner but even embarrassment and shame could not stop me from wanting to be there with mum.  I felt sorry for the already short-staffed A&E department that I was being so unreasonable.  But another part of me could not condone deserting my Mum.  That seemed an even larger more unforgivable wrong.  

I have no answers.  I know so many died alone during this pandemic far from loved ones.  The privilege of those last moments of being there, where it is hardest to be, at the passing of a dear one was denied.  It feels inexcusable and we sense so many other mistakes were made. It is difficult to rectify them all or even reflect on the lessons that need to be learned.  So many hearts have been broken.  Perhaps one solution is to find our humanity again and ensure it is expressed in all the different settings that matter.  One of the important lifelines for those who are ill may well be loved ones.  Even some animals will not leave a wounded family member, surely such instincts should be supported by institutional systems rather than blocked or denied?  

In this depressing world of increasingly isolated living, that leaves so many alone and afraid we must rebuild the vital links with family, friends, and neighbours that fortify all of us.    There are times that instinctually you feel the direction of flow is in a negative direction and you need to consciously head the opposite way.  Perhaps rebuilding broken or neglected human bonds is the upstream movement that all of us need to focus on in these testing times.  

All at sea learning from the past

In this photo, I was 5 years old and had been dressed up for a fancy dress competition on board the P&O Orient ship, Orcades while travelling home to N. Ireland after two years in Australia.  I have few memories of this except my father telling me to smile and shake my tambourine and hips when parading in front of the judges of a fancy dress competition.  I did neither and scowled at them furious that I should be subjected to this cattle show.  This photo captures me on deck just before the competition started blissfully unaware of what lay ahead. (PS when I first posted this Facebook/Meta blocked my posting as obscene, hence the label!).

The skirt is still in this house, stored in a plastic bag in our garage attic.  My Mum stores everything safely and that is why I also found this document below which was stamped on the exact same trip in May of 1964. 

It records my receiving the Smallpox vaccination on board ship.

Smallpox had been the torment of humanity for over 3000 years. In the 20th century alone 500 million died from this dreadful disease.  Just 55 years ago smallpox was still to be found in 30 countries and 15 million people caught the disease every year. Of those 15 million, 2 million would die.  As a result of this in 1959, the year after I was born, the World Health Organization (WHO) started an initiative to rid the world of smallpox. However, this worthwhile global eradication campaign was short of funds, personnel, vaccines, and most importantly commitment from enough countries. Because of these factors, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.  The reason for my vaccination on board ship was that we would be stopping at many of the ports still plagued by this disease.  

The world community did not give up and an Intensified Eradication Program began in 1967 with considerable determined effort across the world. The 33rd World Health Assembly was able to declare the world free of this disease on May 8, 1980. In terms of international public health, the eradication of smallpox is considered an outstanding success.  A united world approach worked and today children no longer even need to be immunised against this dreadful killer disease.  

Today's COVID pandemic has caused a division of opinions as well as suffering and loss of lives.  I have relatives who are convinced the whole business is a conspiracy/fake and are devastated at what they see as their loss of freedom.  Another group of relatives has experienced bereavement and are understandably furious that anyone doubts the seriousness of COVID. They feel angry that vaccinations are not being accepted and that those who refuse them end up filling much-needed intensive care beds.  

As always, we will not know the whole story until much later when we look back at all the successes and failures of various countries and their approaches.  I feel the debate has become too toxic of late.  If we are to learn the valuable lessons from such incidents the level of discourse will have to be elevated not debased.  

Following scientific advice, I decided to vaccinate.  With a vulnerable elderly relative, I wanted to do everything in my power to safeguard them and others in my community.  After all,  herd immunity has succeeded in controlling other contagious diseases such as smallpox, polio, diphtheria, and rubella.  There are always people who for serious health reasons are unable to vaccinate and they rely on the herd protecting them.  It reminds me of how a herd of buffalo forms a circle around the young and vulnerable when attacked by predators. If someone chooses not to take a particular vaccine for ideological rather than medical exemption reasons it perplexes and saddens me but does not make me want to protect them any less.  If they can benefit from herd immunity then I am happy.  It is just worrisome when too many make that choice to remain unvaccinated as it can end up threatening the safety of us all.  More importantly, there are other challenges the world are facing now that will necessitate acting in unity.  Without unity, so many other vital endeavours will simply become impossible.

58 years ago I was part of a courageous and daring world experiment to eradicate a killer disease that had plagued the world for over 3 millennia and we must be grateful to all those who initiated, sustained, and participated in that endeavour.  It is only usually in hindsight that we can see the effects of medical intervention on a global scale.  But even from this present perspective, it seems hostility, division, and toxic debates do little to benefit the well-being of our world community. 

"The well-being of mankind, 

its peace and security, 

are unattainable 

unless and until 

its unity is firmly established."

Bahá’u’lláh

Dynamic Shift

What is it about getting past fifty that heralds the break down of health after decades of well being?  So unexpected to be wandering down hospital corridors and waiting in rooms full of other worried fifty plus individuals.  A sweet couple past me today in Altnagevin hospital he in his seventies with a white stick, with his hand on his wife's shoulder leading him out while she with a walking frame wobbled alongside.  Strangely touched by all our vulnerability.

Dynamic Shift

A belief begins in me
Deep down under all the layers
That change has begun
Years passing blur like
life racing between my fingers
but something within stirs
finds itself and grows
begin and trust it seems to say
the time is now, not later
choose this moment to begin
A dynamic shift within
Makes me think I should dare,
To hope to act, to achieve
To dream big and begin
I watch hardly hoping
But a flicker blazes within.