by Melanie Reid
‘How are you?’ asked Dave.
‘I’ll be fine.’
It wasn’t until I was trying to get from wheelchair to bed, quite late that night, that the pain kicked in as I moved. Pain that had me crying out and vomiting helplessly. I saw my husband’s face turn into a mask. And I saw how swollen the hip and thigh was, the skin starting to go taut and shiny.
You reach a point when so many things are going wrong that there is nowhere to retreat to, not even your own head. I knew I had to take control of the situation, because as a tetraplegic I needed specialist care. I had an absolute dread of ending up in a general hospital where spinal expertise would be lacking. I weighed the odds of a 999 call, at 2 a.m., against waiting a few hours and asking my GP to instruct them to take me to the hospital in Glasgow where the national spinal unit was. In hindsight, it was risky, but it paid off. By nine the next morning the paramedics were putting the patslide under me, transferring me from bed to stretcher, and I was driven back to the same A&E I’d come into three years earlier. By now my hip was vast. Once again, I entered the familiar cacophony, the soundtrack of the NHS in trauma mode. Groundhog day. As ever, my perspective was that of the beetle on its back: the handovers from ambulance personnel; the checks; the forms; the cotton bud up the nose to check for MRSA; the smell of antiseptic hand gel. And how much easier it was the first time, when I was barely conscious, for this time I had the job of having to explain my plight. The exquisite embarrassment of being laid low by horses once more … and repeating the story over and again to registrars and nurses and consultants who looked at me as if I was not just stupid, but spectacularly stupid.
‘You were tetraplegic from a horse-riding fall, and you went back to riding?’
‘Yes’ – gibbering – ‘but to Riding for the Disabled. It was for rehab. It’s very safe.’
‘But you … fell off again?’
‘It was a freak accident.’
But they’d already made their private judgements, and they’d put on that mask of studied neutrality which emergency staff wear when dealing with pitiful street drunks and overdosed addicts and foolish affluent middle-aged sporty types and vomiting Hooray Henry students, every social class finding its method of self-destruction. Their faces spoke of pity and exasperation and weariness, honed to a patina of blandness. Meanwhile, I continued to avoid meeting my husband’s eyes and fantasised that the hospital trolley might slowly fold up and devour me, make me disappear, like a carnivorous plant. I would have really loved that to happen. Then I imagined a cartoon, in the first frame the image of a vengeful, sardonic God, glancing down over a low cloud, with a speech bubble coming from his mouth.
‘I told you to stop horse-riding. No really, I TOLD you to stop.’
And in the second frame, the finger pointing, the bolts of lightning: ‘Kazam!!!’ ‘Boom!!!’ ‘Take that!!!’
The operation was quite a complicated one. I had broken my trochanter in two places, which made it a less than straightforward procedure and, as a result of my failure to go to hospital to be checked out immediately, the bones had been churning around for twenty-four hours. I had lost two litres of blood. The trochanter is the segment of bone at the top of the femur, the part that turns the corner from thigh bone to ball joint. It’s a junction bone. Burning with a sense of desperation about the need to keep control of my body, or what little there was left of it, I described to the surgeon how, even though I was tetraplegic, I had learnt to walk a little bit again, after a fashion, and pleaded with him to repair me in a way which would allow me to continue mobilising. I was not usually a forceful person but I knew I had to be my own advocate in this. I’d heard horror stories of other paralysed people who had broken their hips post-paralysis but, instead of being operated on, had been left to heal as they sat.
My surgeon inserted something called a gamma nailing, a ferocious-looking bit of ironware resembling a long poker with an handle jutting out at the heavy end, the top. The shaft went down the inside of my femur to the knee, presumably by screwing or hammering and brute force – one really doesn’t want to think about these things – and the handle bit screwed into the ball joint. Thanks to a combination of paralysed nerves, a sedative and a low spinal anaesthetic, happily not a general, I slept throughout the procedure.
Afterwards, it’s fair to say, I was a physical mess. My haemoglobin level was low and over the next three days I struggled to talk or lift my head as I was transfused with seven units of blood. And most of all it hurt more than any pain I’ve felt before – despite the fact I was paralysed. My new bedmate was a walrus, a vast, shiny-skinned mountain of sea creature, taut to touch, grafted onto my waist where my right hip and thigh used to be. At least when it was there it meant I wasn’t alone. The walrus wept from a twenty-four-inch scar, studded with dozens of staples. Eighty-four actually; I counted them when they came out. Every single movement I made hurt, including the pain of the cannula twisting in my arm as I lay at night watching the dark syrup drip through it down into my veins.
The thing was, once again I couldn’t resort to self-pity. Once again, my ills were totally self-inflicted. I had been exceedingly unlucky, yes, but I had put myself into a risky situation consciously. I couldn’t even be bothered telling myself that it wasn’t fair. It wasn’t – but that changed nothing, and anyway horses have no sense of fairness. Yet again, I was the mistress of my own destiny. Rather than cry, I beat myself up for being such a fool, for causing my loved ones yet more grief, for giving myself more physical suffering, and for embarrassing myself profoundly. Once again, I fought the seduction of the morphine and tried to plot a way back for me and the walrus. Paralysed people broke bones all the time, post-accident, and were unaware of it until their limbs went blue and started swelling, I reasoned. It happened. It was routine. You went for it, because you had little left to lose. Or rather, you thought you had little to lose until you lost it, and only then you realised how important a ‘little’ was. The logic of risk seemed impeccable beforehand. Forty-eight hours later, after an urgent operation and a hip rebuild, there was no bravado left, just blinding physical and emotional misery. Blurry, relentless. Like looking through a car windscreen in a rainstorm.
Being back in hospital was ghastly; a reminder of how precious home was. Post-op, I was put on an acute surgical ward. Mixed, men and women. During the night it was desperately hot, airless, and I felt the wriggling, itchy texture of opiate on the inside of my eyelids. I tugged my theatre gown up, and pushed the covers down to the bit where the walrus started.
‘Try and cover up, pet. There are men on this ward,’ called the tough voice of a female auxiliary nurse.
Out of nowhere, anger flared. As if it was my fault if a bare chest upset some shitty man? As if somehow in the gloom a glimpse of my sad still carcass with its empty breasts would inflame passion or propriety? What a great metaphor: it’s a man’s ward; it’s a man’s world! Cover up, all pets, all females, lest you evoke evil desires. Briefly, silently, pointlessly, I seethed with rage, the blood pressure cuff tightening on my arm. All those decades wasted fighting that mindset. Did she want me to wear a bloody burka?
Then, amid my lathered internal diatribe, I remembered where I was: I was back on my back; back in the system. I had a master’s degree in surviving the NHS system, if not a PhD, and the way to do it was to lie low, go with the flow, befriend the overworked staff. Chill. Cool your jets. No fancy stuff. No fuss. I pulled down my gown obediently. Life was ordinary. I’d done what hundreds of frail, compromised or elderly people do every day: I’d fallen and broken my hip. That’s not to say I didn’t have to be assertive. In the morning, I explained to the overworked staff that one of them would have to empty my bowels manually. Otherwise I could die. They looked blank.
‘You have to do it, I’m afraid,’ I said. ‘I can’t.’
‘But we’re not allowed to. That’s abuse,’ they said.
‘It’s not,’ I said. ‘That’s a myth.’
‘Sorry, we can�
��t.’
Spinal-injury nursing is a very specialised area and when I had first gone home I had encountered this problem with one of my rota of district nurses, who regarded putting her finger up my bottom of a morning as abuse. I could understand normal reluctance – it’s no dream job – but I had been startled by the implicit suggestion that I was asking her to cross some ethical line. Thereafter, she had been given special outreach training by someone from the spinal unit using a plastic model called Betty Bot. But evidently the myth was and still is to this day widespread among young nurses; and ignorance kept it in circulation. Here it was again. Wearily, I asked to see the senior nurse, and explained that if they couldn’t or wouldn’t do it, they’d have to phone the spinal unit, a hundred yards away, where this was a routine chore, and ask them to send over someone who could. I’m sorry to be difficult, I said, but it’s critical for my care. As I lay and waited, I reflected that mine was a strange world indeed, where I must spend the morning negotiating with a group of complete strangers over the necessity and intricacies of having a poo.
It actually became almost fun, because a senior staff nurse I knew well came over from the spinal unit and gave a tutorial in bowel evacuation to the acute ward staff, clustered around her at my back.
‘You see, I’ve widened your skills base,’ I told them. ‘You should be very happy.’
I’m sure several of them still privately thought it was abuse.
Word of my second fall spread and the head of the spinal unit came to see me; it was like getting a visit from God. Another God, not the cartoon one with the finger firing lightning at me. David Allan was always so fabulously quirky, almost perverse, in his views. He wasn’t judgemental at all about my second horse fall. Far from it.
‘In fact, I see it as a success story because it means your rehabilitation was going so well.’
He cheered me up hugely. Only an orthopaedic surgeon could say something like that. He explained that my trochanter must have been broken in a pendulum motion: as I hit the ground on my left side the right leg had whiplashed across the front of my body and, well, basically snapped itself at the top. I was very grateful to him for his moral support. As I was to my spinal consultant, Mariel Purcell, who snatched time to come to my bedside and dropped her usual cool detachment, expressing real dismay and sympathy. I pleaded with them both to persuade the colorectal surgeon that my colostomy should proceed, as planned, within a few days. I was in the right hospital, after all. My experience that first morning had convinced me that I had to fight for this as hard as I could. The senior nurses had already warned me that more surgery was an unthinkable infection risk while there was an open hip wound not far away. But I decided that consultants were far more flexible than the bureaucratically hidebound nurses and administrators: they were my only chance of making it happen. Graham Sunderland, the colorectal surgeon, came to see me. I pleaded with him; I tried to explain how my bowels had become impossible to manage and I simply could not go home like this, not now, not back to the daily torture on a shower chair when my mobility was even more compromised.
‘It’s too short a time between operations,’ he said. ‘It’s a risk.’
‘Please don’t postpone it. If you lived in this body, you’d understand … please.’
He stood up. ‘You’re a madwoman.’
He smiled and touched my shoulder fleetingly.
‘OK,’ he said. ‘Let’s do it.’
Looking back, it was one of the most humane gestures I have received from a member of the medical profession. Later, I found out that he was a lieutenant colonel in the TA and had done a long stint at Camp Bastion during the Afghan War as a trauma surgeon, saving the lives of soldiers dreadfully injured by IEDs. He was a man who knew that sometimes situations are less than perfect. Risks were in perspective for him.
On the fourth day after the hip, and six days before the colostomy, a physiotherapist arrived at my bedside, a steely look in his eyes. It seemed unthinkable, but he was going to try and manoeuvre me and the walrus out of bed and into a wheelchair. As it turned out, some things were not yet quite possible. With a mouthful of strawberry-flavoured morphine gel and two people’s assistance, I got as far as legs over the bed, propped from behind in an almost sitting position. The right foot didn’t reach the floor but hung in the air, twisted inward by trauma, several inches above it. One gets used to physical symmetry; how strange it is to look down and see when it is taken away. Braced on my feeble arms behind me on the bed, unable to bend in the middle, I felt the world spin around me and the nausea rise.
By day five, I could sit on the side of the bed by myself; and then, with many expert hands and the use of a wooden transfer board, I managed to slide across into my wheelchair. It was as terrifying as a ship-to-ship transfer in a Force 10 must be, because the hip pain seemed biblical – there was the anticipation of it, which was worst of all, followed by the electrical jolt of its arrival. But from where I was right then, mentally and physically, the simple, successful change of position felt epic. It told me I could at least recover enough to be able to transfer myself into a wheelchair again, something I had secretly feared lost. Perversely, then, it was a corner turned: there is nothing like a double dose of disability to make you yearn for a single dose, nothing like two thumps in the face, or two sessions of torture, to make you appreciate just one. It was too much to ask to be healthy, I knew that, but a bit of a miracle to allow me to return to being just four-fifths crippled would be great.
By day six, I was able to get in my chair just with the aid of the nurses, and I started to wheel myself around the bed. There was slightly less pain every day. In the chair I could also access the back of my head with a brush for the first time: by now my bedhead didn’t just resemble an eagle’s nest; in this one you could hear the chicks hatching. Sara, as a kind of penance, came to see me with a tub of detangler and tamed it into a small, severe Jane Eyre ponytail at the nape of my neck. She showed me some of the bruises she had received when the mare mowed her down.
‘What did happen with Nelly?’
She was one of the most experienced of horsewomen, the coach of coaches, a highly rational woman. And utterly direct.
‘When horses go, they go.’
Both of us knew it really wasn’t worth saying any more. The horse world is rather cluttered with people who always know best, who freely pass judgement on everything and nothing. Ignorance holds sway a lot of the time; and blame is a cheap horsey commodity, easily thrown. Sara and I were both wiser than that. When horses go, they go. Nelly went. I just wish she’d chosen a different day.
A word here about blame. Sometimes, in the early days after my neck break, people who didn’t know me very well would ask me if I was going to sue. Someone, anyone. I found the concept strange. Why ruin someone else’s life as well as my own? I can well imagine the trauma that the instructor who was teaching me that day must have experienced; indeed, much later, from a third party, I learnt of her distress. I was sorry that she got hurt too. All this came rushing back to me at the time of the famous rescue of the Thai boys from the cave. The football team had been taken into the caves by their coach, Ekapol Chanthawong, and the Western media was straining at the leash to blame him. The response from the parents exposed the beauty of the Thai culture against the ugliness of our own. ‘If he didn’t go with them, what would have happened to my child?’ said the mother of Pornchai Khamluang, one of the boys in the cave, in an interview with a Thai television network. ‘When he comes out, we have to heal his heart. My dear Ek, I would never blame you.’
By then I was able to transfer from bed to chair without any fast-acting morphine at all. The sickening bolts of pain had gone and the physios produced a special power-assisted frame to get me upright. Crying out at the shock of seized joints being wrenched open, I managed to stand up for a few brief seconds and my left knee straightened a fraction. The surgeon told me I could start weight bearing on my repaired hip but so far the knee was too crooked to l
et the foot reach the floor. Just before the second operation, as if to reassure me that, however bad things were, they could always be worse, I was transferred to the female orthopaedic trauma ward. In reality, it was a geriatric hip-repair ward, where tiny old ladies, white-haired sparrows, lay in serried ranks with their broken hips, confused and plaintive. Of all my time within NHS walls, this was the saddest place. This was where they came, the demented and the rambling, when they fell in care homes and broke their bones. Often, when I heard nurses being harshly criticised, I wished their critics could spend the night on one of these wards. Listening down the cavernous empty spaces of the small hours, when the misery ratcheted up and the soundtrack soured. That was when, unseen behind those same thin curtains, many of the patients turned into aggressive banshees, goaded by dementia and pain.
Here were yet more unwritten comedy scripts, humour at its blackest, the foul-mouthed Glasgow grannies turned comic assassins. It was rather wonderful hearing women swear like this.
‘Yer fucking bastard, get your fucking hands off me. Aaaaaargh, yer fucking bitch, you’re hurting ma leg.’
And the calm, pleasant voice of reason: ‘I’m not actually touching your leg, Jeannie, please mind your language, now if you could just roll a little to the left.’
‘Away tae fuck, yer fucking pest.’
‘Jeannie, please stop trying to hit me and roll to your left.’
Simultaneously, there were other conversations going on. Full volume.
‘Yes, Mary? You buzzed.’
‘What’s your name, dear?’
‘Linda.’
‘Brenda?’
‘Linda.’
‘Brenda?’
‘LINDA!’
‘What time is it, dear? I need to go home.’
We never hear about this, when standards of compassion in the NHS or in care homes are criticised. We never read in reports about the effing and blinding and theatre of street abuse – or hear the sounds of bashing and crashing as the patient flails at the nurses. Humanity at its most raw and painful. The other little old ladies and me, those of us still in possession of at least some marbles, cowered beneath the blankets. Then morning came and I found myself being prepared for the colostomy operation – my insides flushed, my consent sought, my watch removed. On one side, the aching long hip scar, but now there were fresh body maps – black marks inked on my tummy, guidance for the surgeon as to where to fish out my guts to the surface. Go in here. The dreaded black spot. And then, in what seemed only ten minutes later, I was back in bed but had a bit part in Blue Planet, exploring a whole new exotic underwater world. The friendly walrus was still there, in place of my hip and thigh, and he’d been joined on the other side by a bright red sea anemone, as rare and perfect as anything ever glimpsed through a diver’s lens, which blossomed on my stomach.