An accretion of brutality, 12/05/17

“Came up running, maybe faster than anyone she’d ever seen run, straight out across the garage, down the long line of what they’d said was Lev’s father’s car collection. As he ran, each long arch lit up with its glow stuff, so shallow they might almost have been beams, to fade again as he passed below, and she hadn’t imagined there were so many, or how big this place was. As he ran he screamed, maybe how he hadn’t screamed when what happened to him had torn so much of his body off, but between the screams he whooped  hoarsely, she guessed out of some unbearable joy or relief, just to run that way, have fingers, and that was harder than the screams.

Then one last arch faded when he ran beneath it, and there was only darkness, and the sounds he made.”

William Gibson, The Peripheral

The first time I read this paragraph, I thought it was an extraordinary thing – beautifully and terribly human. Here, now, suddenly having my leg free of the metalwork to which I’ve been bolted for 10 months, my eyes shimmer with tears. It describes a man abruptly free of the awful physical injuries that have come to define him and perhaps seeing past the emotional trauma that was grafted on with them. His wounds are far more grievous than mine but, you know, fictional. When I look at the list of what my body has endured over the last 31 months, it’s a blankly terrifying accretion of brutality. I’m glad it was spread out. In summary:

10/11/14

Left brachial plexus neuropraxia – I stretch the nerve cluster that moves my left arm, paralysing it. As I am hanging by it at the time, I fall 5 metres, sustaining an open right tibial fracture and a fibula fracture. I bounce 30-40 metres, during which: fracture left ribs 4-10 (that’s 7 ribs in total); right clavicle fracture; fracture thoracic vertebra 6; fracture transverse processes on thoracic vertebrae 5 and 6 and on lumbar vertebrae 1 & 4; fracture spinous processes on sacral vertebrae 1 & 2. I lie on my own for somewhere between 8 and 9 hours. The sensation of one half of my tibia rubbing across the other half is genuinely the worst thing I have ever felt. I am airlifted to Newcastle Royal Victoria Infirmary.

11/11/14

Picture of surgical scar on author's spine.

Magnificent scar

An intramedullary nail (basically a titanium rod) is inserted into one half of my broken tibia and the other half is slotted over the other end and fixed with screws. A tissue graft is lifted from my right calf and slipped under the open flap of skin, which is then stitched closed. A skin graft is taken from my right thigh to cover the bare meat on my calf.

 

 

12/11/14

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No, this is a magnificent scar…

The two vertebrae on either side of my spinal fracture are stabilised with titanium Meccano. I gain a magnificent scar. It’s not as magnificent as my leg scar, but it’s pretty dapper.

I’m not sure of the date because: morphine.

At some point after leaving intensive care but before I am moved to Leeds General Infirmary, and deep in the clutches of morphine induced Bruce Willis hallucination (no, honestly), I try to manually remove my own catheter. Even through the opiate cloud, it is eye-watering. Don’t try this at home. Or in hospital. Ow.

29/06/16

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The horror, the horror, the horror…

Because my tibia was exposed for such a long time, the bone has not healed. The intramedullary nail is unscrewed and removed – I dread to imagine the mechanics of this process. The surgeons cut 3cm of dead bone from my tibia and shunt the two halves together. Then they put 12 pins through the bone and fix them externally to a series of stainless steel rings – an Ilizarov frame. Just for clarity, my right leg is now 3 cm shorter than it was, and my muscles and tendons contract to the new length.

10/08/16

So that I can stretch the missing length back in with the frame, I have a corticotomy, which is to say that they re-break my leg. With a drill. And a chisel. I Google corticotomy to find out how to spell it; the first search result is a YouTube clip of an actual corticotomy. I’m lucky that way.

18/08/16

The old break is sufficiently healed that I can start opening up the new break. I turn the nuts on four bolts 0.25mm three times a day. As the gap widens, the pins gradually stretch my flesh. It’s an extraordinary sensation. This will continue until 29/09/16.

28/10/16

I snap a pin. The torsion from widening the gap coupled with 4 months of my being possibly more active than the average patient distorts and then breaks one of the pins on the bottom ring. The pin is pulled out and then a new one is driven through my leg. Not in the old hole, no. They make a new hole. Of course. This is my third nerve block. When it wears off, oh my word.

12/01/17

At a regular x-ray, I point out that the two pin sites in the middle of my calf weep quite a bit. As the pins are supporting the old break, which has healed, and provide a potential avenue for infection, they are removed. With pliers. I get gas and air. It’s not painful exactly, but when you pull metal through skeleton, it generates friction, which generates heat. When the hot metal emerges from your skeleton into your flesh, it is quite odd. Oh, alright, yes, it is also painful. Ow. Again.

16/03/17

I snap another pin. No, I don’t understand either. It’s like they don’t make these frames for people who, I don’t know, walk about. Anyway, this time, my consultant just takes out the pin clip and puts in a longer clip that reaches in to grip the snapped end. This means I do not have to have the pin replaced. All of the hurrah. The frame tinkering transmits all the vibration directly to my skeleton. The piercing nausea is quite distracting. Also, I have an ingrowing toenail on my big toe. It’s clearly not the gravest of my woes, but straws and the camel’s back, eh?

20/04/17

My consultant tells me that if I promise not to rock climb, he will loosen off the frame and then remove it in three weeks. He takes the nuts from the supporting bolts. As they are under tension from holding up 76kg of idiot, they have seized up. Another surgeon has to hold the frame while he loosens them. Again, the vibration is transmitted directly into my hard infrastructure. It last seconds and forever. Ow. Again, again. In addition, now the that the nuts are gone, the frame can flex. When the bolt threads rub across the rings, it is a brand new crack in Hell’s paving.

11/05/17

After a further x-ray, the consultant decides that the frame can come off. The pins are all

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As good as new. Well, better than broken.

snipped through with bolt cutters. Some of them take some cutting. As the pins snap, the tension they are under is released directly into my skeleton. One of the pins at the bottom is actually really loose – I watch the nurse prod it back and forth with her finger before she plucks it free. The rest are not loose. Oh, no. They are well and truly ossified in place. Most of them are heaved free with some accompanying sacrilege on my part. (Honestly, they’re missing a trick here; if they mixed helium with the gas and air, this could be primetime viewing. The show would have it all: blood, drama, tension, human frailty, really squeaky blasphemy. I digress.) A burly male nurse is brought onto the pitch for the stubborn pins. He is able to shift all but two of them. I invent some new compound swears. My surgeon is brought in. He takes what is basically a drill chuck on a T-handle, and clamps it to the end of a pin. Two nurses hold my leg down. The surgeon heaves on the pin. The third nurse hits the pin from the other end; I have my eyes closed and have no idea with what. I inhale gas and air all the way down into my pelvic girdle. My left leg (the good one) actually goes into spasm. There’s a fair bit of blood. One more pin to go. See previous pin. Peace, the charm’s wound up. My leg is dressed and encased in a rigid protective boot and I am released into the care of a responsible adult*.

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Tibial triptych. It’s a bit more colourful than the Isenheim altarpiece, but about as grim.

12/05/17

And here I am. In actual trousers. And socks that come up over my ankles. And underpants that don’t contain Velcro. It’s been an astonishing process: humbling, painful, life-affirming, somehow simultaneously bright and befuddling. I’m sure that I have not been easy to deal with; I can only apologise. If it’s any consolation, it’s been less fun being me than being around me. To everyone who has altered clothes for me; visited me in hospital (especially if you bought coffee); done shopping for me; dropped by at home to see how I’m doing; taken me to the pub, cinema, shops or physiotherapy; done laundry for me; cooked for me; changed the bedding for me; carried stuff for me; put up with me on Twitter, the ‘phone or real life; driven me to, waited around for me at, or driven me home from the hospital; done something for me that I’ve forgotten – thank you all, I am in your debt. A special thank you to my team at work, who have been so supportive of me whilst probably dealing with me at my worst: you rock.

And just for clarity, although this post references brutality, the care I have received from all of the staff at both Newcastle Royal Victoria Infirmary and Leeds General Infirmary has been superb. I am grateful to them all and sorry that, on occasion, my circumstances have got the best of my temper.

*no, really

Aren’t you better yet? 02/03/17

“Singing six months ain’t no sentence, and one year ain’t no time”

Junco Partner, The Clash

Forgive me, Father, for I have sinned. It has been 5 months since my last confession. Where has the time gone? I am, I think, in a state of shock, so this will be a bit of a stream of consciousness as I try to put my thoughts in order. Let’s get you all up to speed, and then I can crack on with recent events.

When last seen, I was enjoying a ferociously strong gin and all of the extended cuts of The Lord of the Rings. I say enjoying – I still resent the way that Gimli was gradually turned into comic-dwarf-relief by the screenplay. Also, Strider wasn’t scary enough and his character arc was crammed into some unnecessary, producer-driven three act structure. I digress. This isn’t getting you up to speed.

Scurry forward to mid January and I am once more in orthopaedic outpatients at Leeds General Infirmary, having my lower right leg irradiated. In the subsequent x-ray, there is perhaps twice as much bone as in December, and it is much denser. The screen shot here is of the lateral x-ray. You can see the bone is filling in from the back forwards. This is because all the muscle and therefore blood supply for the tibia is at the back, in the calf.

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Lateral x-ray of my right tibia, in all its happy glory.

I point out to my consultant that two of the pins weep quite a lot when I am active. They are supporting the old break, which has now healed, and so are functionally redundant. They are removed. With pliers. I get gas and air. It’s an extraordinary sensation. Not painful as such, but the friction generated by metal pins being drawn through my skeleton is quite something. Would not recommend.

In the run-up to this x-ray, I’ve stopped using crutches indoors and, after it, I stop using them altogether. This is important because weight-bearing triggers a nerve signal to make the bone grow. The more bone is in the gap, the more I can weight-bear. The more I weight-bear, the stronger that nerve signal. The stronger the signal, the more bone grows into the gap. Repeat.

At physiotherapy, I’m now working on a lot of single-leg balance exercises and I’m moving 80kg on the leg press (I weigh about 76kg, so I’m pressing more than double bodyweight). Elsewhere, I’m getting down to the shops and back with around 4kg of shopping and without crutches (albeit incredibly slowly). I’ve very gradually phased prescription painkillers down and then out. After the end of January, I phase out over the counter painkillers too. That’s a relief, I can tell you. Not just because of the freedom from opioids, but also the lecture every time I buy cocodamol. Oh dear me, yes. “Have you taken these before?” I think you could say that we are acquainted, yes…

My February x-ray gets bumped on to the start of March. Out of interest, I get my thumbs into the gap in my tibia. It feels like it’s full of bone. There’s a little bit of a hollow, yes, but the consultant has told me that there will probably always be a concavity on the front of my shin. But am I just feeling bone because I want there to be bone and my mind is making up the difference? And, good grief, I cannot tell you how much I want to be rid of this frame. It weighs 2kg. The ends of the pins are sharp and catch on everything. You can never forget it’s there, even in bed. Actually, especially in bed. I can only shower my right leg once a week, so it’s constantly sloughing greasy, dead skin. I’ve been wearing 3/4 of a pair of jogging bottoms for months now and I’d quite like to just put on some trousers. Or jeans. Maybe even jeggings. Oh yeah, and I’ve basically got 12 knitting needles entirely through my leg and that is exactly as comfortable as it sounds.

My March appointment arrives. I have my x-ray more or less on time, but when I get back to clinic, they are running almost two hours behind. I manage to distract myself from daytime television (why, hospitals, why?) with a book. Eventually, I’m called in. There on screen is the familiar shape of my tibia, sort of full of bone on the frontal x-ray. The obliques are a bit less convincing. Ignore the breaks in the fibula, gentle reader, because #FunFibulaFact: most of the fibula is functionally redundant. The bottom fits into the ankle, and the top anchors some ligaments; the rest is ornamental. Eyes on the prize, team, back to the tibia. Is it dense enough for the frame to come off? Spoiler alert: it is not dense enough for the frame to come off. The consultant loosens the upright bars on the frame to take some of the tension out. This will allow more of my weight to go directly onto the bone – see mantra above abut weight-bearing. I will come back in 7 weeks and he will loosen it again, completely. Then, in another fortnight, he might take the frame off. I am, in the finest tradition of disqualified Masterchef contestants, gutted. (Seriously, though, Masterchefs, learn a new adjective. Also that bit where they say “It’s not gonna stop me cooking”? Just once I’d like to hear “Sod it, it’s ready-meals from now on.)

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Ignore the fibula (the one on the left). Nobody cares about the fibula. It does nothing, the slacker. I’m thinking about having it removed.

Pretty much in shock, I hobble into Leeds, get the train to Bingley, get some shopping (not the celebratory meal for which I was hoping), get through my front door, sit on the couch and cry. Not very loudly or for very long, but all on my own and with another 9 weeks in the frame looming before me. And yes, there is and end in sight. And yes, I’m lucky to be alive. And yes, it could have been worse. And yes, and yes, and yes, and yes. If all you have for me is platitudes, please hold your breath. Keep holding. Keep holding. Keep holding. Keep holding. Keep holding. Keep holding. You can do it. Keep holding. Annnnd you’re unconscious. Excellent.

So, where were we? Yes. Another 9 weeks of this. Obviously I can do it. My remarkable body and my little, thug heart will keep going because that’s what they do. My beleaguered mind – always the weak link in this chain – is right at the end of its tether. I was prepared for “we might have to leave this until April”, but May? May? That’s a whole load of plans I had for May just set on fire in a skip. Messrs Strummer and Jones are incorrect. One year is quite a lot of time, and it seems that I cannot remember my life before this cage. And I am crushed. Right, I have to go and take my mind off this, but I just needed to get it all off my chest. Thanks for listening.

Two years later,10/11/16

“Yesterday, in my 4th operation, the surgeon put a chisel through my tibia. I can conclusively assert that the first cut is not the deepest.”

Me, affecting bravado on Twitter

Two years ago from more or less the time at which I post this, I was dangling by my left arm. Not nonchalantly, no, more in blind panic – very literally clinging on for dear life. My right hand, to be fair, was doing its best to get me latched back onto the rock, whilst my feet scrabbled for purchase on the overhang. Below, a good 5 metres of gravity beckoned me towards an uncomfortable reckoning.

My left arm did its best – for all that I’m right handed, it suspended me for a remarkable span. I vividly remember the enormous surge of adrenaline;  the baffling, committing, all-or-nothing power in my forearm; the tension in my left bicep; the calm voice in my head saying “get your game face on, this is going to hurt”. I hung on my left arm until I stretched the brachial plexus – that’s the nerve cluster that the works it – paralysing it.

Then I fell.

I often wonder how I must have looked, tumbling down the side of the crag. Was my face creased in pain? Terror? Was it blank with grim acceptance? Did I cry out? I remember the the sensation of my skeleton breaking far less clearly than the sound. At what point did unconsciousness drag me from my horror? Was it before or after my helmet was torn from my head? As friction overcame gravity did I gently slide to a halt in unlikely, cinematic grace?

I will never have the answers to much of this, and perhaps that’s for the best. I may never regain feeling in my left arm – now numb between elbow and shoulder – or across my left shoulder or down my spine. I am very happy to be here, though. Deeply so. And I am genuinely grateful to people and hounds of Keswick Mountain Rescue Team for scraping my bloody ruin off the mountain in such awful conditions. I genuinely owe them my life, just as I do, the staff of Royal Newcastle Victoria Infirmary. Thereafter, Leeds General Infirmary and St. Luke’s Hospital (Bradford) have expended considerable resource on my continuing recovery. Thanks to all of you.

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Cheers! Yes, it’s 58% ABV. Who needs codeine? (please drink responsibly)

I have much for which to be grateful. I have set aside today to ponder that, not with solemnity but with quiet and intense joy. And with a ridiculous navy strength gin. I don’t normally drink in the week or this early in the day, but I feel I’ve earned this. Cheers.

A plan is just a list of things that don’t happen, 01/11/16

“[…] I am in blood
Stepped in so far that, should I wade no more,
Returning were as tedious as go o’er.”

Macbeth, Act III Scene 4

Well, my right leg is the correct length and I have the terrifying x-rays to prove it, but I’ve been able to feel the frame flexing and I’ve not been able to move without crutches for a few weeks. Anyhow, last Tuesday, I noticed I had sheared through one of the pins that run through my tibia. I had a consultant appointment by Thursday and was in surgery on Friday. The frame is much more stable and I was able to manage a few steps without crutches before the nerve block wore off. Thanks to RP for collecting me from hospital and for indulging my craving for fish and chips on the way home. I owe you one. Not enough to listen to Whitesnake, mind, but I am in your debt.

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There’s bone in that there gap.

It’s now just a matter of waiting for my tibia to fill in the gap with bone, so I thought I’d write about some of the things I’ve learned over the past couple of years. Some of this stuff is already in other posts and some of it isn’t. Don’t judge me – we’re all desperate for content. Except perhaps you, gentle reader. Don’t give me your troubles…

Long term use of non-steroidal anti inflammatory drugs may inhibit bone growth. I learned this not long after I’d seen the state of my leg for the first time post-accident. Good grief, it was swollen. I asked the nurse if I could have something like ibuprofen to bring the inflammation down. I couldn’t. The swelling only came down, in fact, when it encountered a combination of Iyengar yoga and hydrotherapy. And now it’s gone back up again.

Ribs are a really important part of breathing. Nearly as important as lungs. Yes. You (or anyway, I) don’t fully grasp this fact until you break a load of them. Then you grasp it really very firmly indeed. That’s why surgeons can’t do much with broken ribs. If you strap them up, they can’t expand and if they can’t expand, you can’t inhale and that really makes for issues much further up the triage ladder. I didn’t sneeze for about four months because I couldn’t get air into my lungs quickly enough to expel it reflexively. It was odd.

I was on the fell for somewhere between eight and nine hours. The selfie on the post about the accident was taken (when I look at the info on my iPhone) at 12:38, meaning I probably peeled at around 13:00. When I recorded for the Listening Project, MB told me that they got to me somewhere between 21:00 and 22:00. Gosh.

I wasn’t found by dogs. Again, when I recorded for the Listening Project, MB told me that there were dogs but they didn’t get there until 10 minutes after he did and he didn’t get there until 15 minutes after I’d been found. The mind, let me tell you, is an odd and powerful  beast.

The tibia is a difficult bone to regrow – apparently I’d have been better off breaking my thigh bone. The femur is surrounded by muscle and so has a good blood supply and therefore a good nutrient supply. The tibia is mostly surrounded by skin. The tissue graft that they took from my right calf and slapped over the break? I think the point of that was to increase blood flow around the wound and so speed healing. Only the bone was dead. Just my luck…

And here’s some stuff for those of you that have been injured (or may yet be injured – I hope you won’t be, but if you are, you may this useful).

img_0091Crutches: get yourself some fingerless gloves – they’ll save your palms. I have belay gloves because, you know, climbing, but weightlifting gloves would be good too. Also, some kind of shoulder bag for moving things around the house – books, flasks of coffee, guinea pigs – while your hands are full. Mine is from Maxpedition and sits on really comfortably on my hip, across my abdomen or lower back. When not in use, crutches are such a pain to balance. No, they really are – you can’t appreciate this until you have some. Balance them upside down. If you learn one thing from my blog, learn this. You’re welcome.

There shouldn’t be any flex in an Ilizarov frame. If you can feel it shifting about, that’s not right. Don’t panic, but do make an appointment with your consultant. Seriously, don’t freak out – you probably just need the clamps on the pins tightened. You’re going to be fine. I’ve had a pin replaced. I’ll be frank, it wasn’t fun. The surgeons pulled the broken pin out and then inserted a new one in a brand new hole. I’m told this is more hygienic. The nerve block has worn off and I’m in some considerable discomfort, but it’s going to be fine, and so will you.

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You should not be able to do this with any of the pins. No. Call the hospital now.

Everybody’s experience of injury and surgery is unique to them. Their physical and emotional response is theirs and theirs alone. If it’s the first time they’ve been through the mill, there’s nobody to teach them the ropes. Surgery is hard, gosh, but it is. The drugs and the anxiety and the sheer physical brutality of what happens while the lights are out  – it all comes at a price. Be patient with them. They’re doing their best in difficult circumstances. Questions that are basically “why aren’t you better yet?” are not helpful. Close the hole under your nose and think before you make any more noise come out of it.

Similarly, if you’re in the trauma club and your patience is being tried by well-meaning but unhelpful loved ones, try to cut them slack. They don’t know what it’s like to be trapped in your sack of scars. How could they? I certainly didn’t understand before I tipped off the world. When I first came round in hospital in November, 2014, I thought I’d be back at work by Christmas. I wasn’t back until May, 2015, and I’ve just spent my fifth day in surgery, earning two new scars.

Speaking of scars…
…deep scar tissue is a strange thing alright. There’s an oddness where the numbness between the surface and the tissue that can still feel is almost a physical presence itself. It will cling to your skeleton and slow you down. In addition to the scars, there’s the fascia tissue – this is wrapped around your muscles. It clamps down around your muscles when they’re subjected to trauma, limiting their movement. My word, does it clamp down – almost two years down and it’s still a problem for me. Once the wound is stable, think about seeing a sports physiotherapist. They can help break down the scar tissue and they’ll free up the fascia. It will be uncomfortable and expensive. In my first session, my left shoulder was given a Chinese burn that went on for 15 minutes. I thought I was going to cry, and believe me, I can soak it up by now. It will be worth it, though.

So, I think that’s all I’ve got right now. Or, at any rate, all I can get to the surface through the mound of codeine. Perhaps I’ll add to this in the future. If you know anyone who’s going through the wringer with physical injuries at the moment, and you think this will help, please share it with them. If you’re going through the wringer, remember what I said about unique personal experience. This is written solely from my point of view. Some of this will chime with you, some of it won’t. The bits where we part company don’t mean you’re getting it wrong. You’re just you. Stick with it; you’ve made it this far and you can see it through.

On the bright side 27/09/16

“Yeah…well…you know what Napoleon said: Give me a man who is lucky.”

Spartan

So I’ve been cranking open my tibial break by 0.75mm a day since the 18th of August; by the end of this week my right leg should be the correct length. This is really quite a big deal. After that, it’s just a matter of how quickly I can fill a 30mm gap with bone tissue. I might be rid of this frame in January.  Anyway, I thought I’d try to write about the positive things that have emerged from all this horror.

Before I get to that, three caveats.

  • I haven’t coped with this all on my own – it’s been a team effort. Thank you so much to those who have helped me.
  • I have certainly wallowed in this, I’ve been selfish, used my injuries and medication as excuses, and I’ve let people down. I’m not trying to gloss over my multitude of flaws, but I do (for a change) want to focus on the good things about my flirtation with the infinite.
  • Everything is relative (except Newtonian physics – I ‘m pretty certain they’re absolute). There are people who have suffered much more than I have – I empathise with them, but I can only talk about my own experience.

Resilience
Um…it seems like I’m pretty tough. Not in a ridiculous, macho way; more in a I’ve survived a lot and kept going kind of way. Surviving the fall was absolutely a matter of luck rather than physical prowess. Keeping it together for eight hours or so, though, is absolutely the hardest thing I’ve ever done – I don’t really have the words to explain how grim that was. The genuine strangeness of the next week or so in intensive care is a close second. And then the tottering months following discharge, working my way back to some kind of fitness only to find that, no, there’s still more to come: more surgery, more pain, more dizzying medication, more struggling on crutches, more physiotherapy. And yet, here I am – head up, leg elevated (just now while I’m typing, not all the time; that would be impractical), looking at a point where I might be able to get back to doing the thing that nearly killed me. There’s no I in quit. No, wait, that’s gibberish – there is totally an I in quit. There’s no quit in me. Yes. I mean no. And first caveat notwithstanding, when I’ve been down at the bottom, when I’ve been riddled with doubt and, for that matter, physical pain, it’s really been me that’s soaked it up and got on. I did that.

Self discipline
I’ve absolutely stuck at it. I’ve seen a lot of people in physiotherapy who aren’t keeping up to their exercise regime between appointments. I’m not judging them because I don’t know their circumstances. I do know that the NHS, in as much as it has one, has waved its magic wand. The rest of this recovery is down to me. Only I can rebuild muscle, bone and the less concrete attributes like balance. I’m sticking to exercises I’ve been given and more generally doing what I can to regain strength. I’m getting to shops and back, on crutches, with shopping; to stop my toes curling under, I’m working on Adho Mukha Svanasana a little every day; to rebuild grip strength, I’m handing my bodyweight from my fingerboard every other day, gradually building to smaller and smaller holds.

Four of these nuts, 0.25mm a time, three times a day.

Four of these nuts, 0.25mm a time, three times a day.

Admin
No, you shut up. Seriously, managing medication on medication is quite a feat. Codeine really affects my grasp of how time is passing – when you’re on the limit of your daily paracetamol allowance for prolonged periods, you can’t afford any mistakes. In almost three months, I’ve only lost the thread twice; and I made the right choice – if you’re not sure whether you’ve taken them, assume that you have. Likewise, I’ve kept track of extending the frame: 0.25mm, three times a day, every day. The one time I got confused, I got myself back on track the following day. The admin is dull but by no means trivial.

Good people
More by luck than good judgement, I’ve surrounded myself with good people. My parents have helped me out hugely, caring for me for months after the accident and helping me out with shopping after my recent operations. Friends have visited me (with coffee) in hospital, raised money for Keswick MRT, put food in my freezer, changed my bedding, driven me around, helped me get to the shops and back, modified my clothing.  My employer has really looked after me – not just meeting its contractual obligations, but being really human about my rehabilitation. The members of my team have covered over the holes I’ve left in various rosters, picked up my slack, and sheltered me from cold, cold world outside.  So, caveating my caveat about my first caveat – thanks, everyone.

Look how majestic I am! disclaimer: actual majesty may vary.

Look how majestic I am! disclaimer: actual majesty may vary.

Death
None of my injuries were, in and of themselves, life threatening. In combination with one another and hypothermia, I have gazed in awe on my own death and been returned. It’s gradually given me a slightly different perspective on life. I’m not saying I’ve got that all the time, and silly things still get under my skin. But when I’m there, it’s odd and refreshing to be staring back into the world from death’s grey kingdom. Hello, you

 

An age of marvels, 07/08/16

“This shouldn’t hurt, but you might feel a slight discomfort.”

The Hold Steady, A Slight Discomfort

So, the district nurse bottles removing my stitches two weeks running – they’ve been in for four weeks now. I make an appointment with my GP practice nurses. They are hesitant when they see my frame but as soon as they hear the district nurse baulked at it, there’s no stopping them. It takes two nurses 45 minutes to get them out and they have to have a time-out in the middle. They are heroic, though, and I salute them. The following day, my leg aches just from tensing up for so long. And it is quite the picture.

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Air-drying is not the only way in which my leg resembles a ham…

I’m physically competent enough to shower now, which is a relief. No more flannel baths for Marquis. I have to pull a bin liner up over my right leg and strap it in place above my knee (to prevent infection, not oxidation – titanium doesn’t rust). Once a week, when the pin site dressings are changed, I can shower fully. I strip out all the dressings and then let the pin sites air-dry until the dressings are replaced.

The appointment with my consultant arrives and I am x-rayed to see whether the tibia has sufficiently healed for it to be re-broken. Normally, they would crack the bone when they fit the cage. Because they also had to remove an intramedullary nail, my leg swelled up too much to take all that punishment at once. The surgeon is pleased with how I have healed, which means that he can now drill a series of holes across my tibia and then put a chisel through it. Then I use the frame to crank the gap open by 1mm a day – my bone will grow into the ever-widening crack until I’ve got back the missing 3cm. What, as they say, a time to be alive. For all the incoming brutality, it’s a massive relief. I’ve had 20 months of no-growth in my tibia and it’s a huge weight off my mind that my skeleton is back in the game. Crikey.

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Good news, Lyndon – we can now put a chisel through your tibia.

I return to physiotherapy at St. Luke’s. I’ve spent so much time here over the past year and half that it’s a sort of homecoming. Unexpectedly, they have me working on some quite heavy equipment on the first session. I keep going until my leg is shaking with the effort. Repeat on every session.

I meet a young woman at physiotherapy who had an Ilizarov frame fitted by my surgeon. She was told she’d need to wear the frame for a year, and yet had it removed after 3 months. She’s 20 years south of me, so I imagine she heals more quickly, but it’s good to hear some  positive affirmation of the process. She warned me that the first time I put my weight on the new break, it’s going to feel really alarming. It’s going to feel like something terrible has happened but that the medical staff aren’t going to alert me to that. I was grateful that she took the time to share her experience of the procedure with me. One of the positives out of all this is the camaraderie among the patients; those that have already trod the path coming back to show me the way. Thanks, HB, if you’re reading this.

It’s been an emotionally overwrought month. I’ve cried at two episodes of Castle now, and a Lie to Me. Good grief. They were all episodes where characters were being physically rescued. Feeling impaired has set me pondering what a profound experience it is to be rescued. I don’t think that, even after all this time, I’m quite over that huge crest of relief when the cavalry showed up for me. Gosh, it was a colossal moment, such a huge heart-shaking thing to experience that sudden reprieve from the infinite. Forgive my lack of clarity here – it is difficult to articulate because I’m not entirely sure what I’m feeling. To physically damage yourself to the extent that you will die unless somebody steps into save you; to absolutely understand that in that moment; to be saved amidst the certainty of your own death – it is a big thing to process, and I’m still in the middle of it. Which is fine. It is what it is, but I need to acknowledge what it is and that it is affecting me.

And while I’m on the subject of danger, it’s time for a sweeping generalisation. I know I shouldn’t speak for everyone who’s been to the brink, but I just need to get this off my chest. If you have a loved one who’s survived a life-threatening  ordeal, please think twice before you utter the words “it could have been worse”. It is a thing you say to comfort yourself* and not to comfort them. The notion that they might have suffered more than they did will in no way mitigate the suffering they have endured. And, believe me, they already have an iron grasp of the fragility of human life without your insight. If they’re like me, they’ve already devoted a lot of time to thinking about how much worse it could have been. My favourite scenario is where one of my seven broken ribs punctures my left lung and then I drown in my own blood; I’ve spent hours rolling that one back and forth behind my eyes. They get to say “it could have been worse” and you get to listen – that’s the deal for this. If something dreadful happens to you (and I genuinely hope that it does not) they will return the favour. And because they themselves have spent some time lost at the bottom of the world, they won’t try your patience with platitudes.

*this is a legitimate need – you’ve had a terrible fright – but it needs to be kept separate from their need

Learning to live with Ilizarov, 21/07/16

So, it’s now twenty three days since I woke up with my lower right leg in an Ilizarov frame, and I think it’s starting to settle. It’s genuinely the oddest thing, and I’ve no idea how to explain to you how it feels. There was a moment where I clattered my left leg with the frame that’s pretty vivid and easy to describe: it was like both legs had been simultaneously dipped in ice-cold water and set on fire. Behind the inner howl, I could hear a very clear voice saying “we are never doing that again.” It’s been right so far.

What else? Hmmmm, on the Sunday after I was discharged I had a bit of a meltdown. The frame felt cold and I started imagining I could feel that cold in my bones and then panicked that I might never be free of it. There may have been some tears. Possibly snot. I perked right up after I ate something so perhaps it was low blood-sugar.

And the sleeping, oh, mother of grief weeping on the shores of sorrow, the sleeping. I’m not sure how much the frame weighs but it’s really pretty big. I naturally prefer to sleep on my side, and I’ve had to find a way to support all this metal so that I can get off my back in comfort. In fits and starts, I’m getting around 6 hours a night. I realise that, to many, this is a lot of sleep. I normally do 9 hours at a stretch, and I really need my sleep at the moment. I’m up, out of bed and downstairs before 07:00 every day. It’s strange.

They did a pretty decent job of tidying the frame in theatre, but there are still twenty sharp titanium ends ever so slightly proud of the rings, and they catch on everything. I’ve got two old pillows, two bedspreads and a mattress-topper to protect my furniture from the scratches and gouges.

Toenails. Oh, toenails. They’re still covered in blood and a gosh-awful long way away. And

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Blood? Where was your right foot on the night of the murder?

long, so long. They’re talons. I wish I’d cut them before the operation. With some huffing and pain and quite a lot of profanity, I clip and clean them. Touching my swollen foot is still a very odd sensation, so the blood between my toes is staying there until I sweat it off. Oh, the glamour.

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Medication time! Medication time!

I’m summoned to see the consultant at a day’s notice. It’s taken me 6 months to get an appointment before, so this a novel and alarming development. Apparently my blood tests show that there may be an infection in the bone. I have to take a course of antibiotics. The prescription is faxed over to the hospital pharmacy and I’m left waiting around 40 minutes for it. When it arrives, I understand why – it’s actually a carrier bag full of antibiotics. If you need clindamycin for anything in the near future, I’m sorry – I have all of it. I’ve got 504 capsules to get through, on top of my pain control medication, calcium supplement and vitamin D. Gosh, I’ve got a lot of pills.

The first time the pin site dressings are changed, it takes two districts nurses over an hour (this isn’t a complaint – there are forty pads to replace). The second time, we’ve got a system going. I strip the old pads off while they cut up new ones and clean the pin sites, then they re-dress with new pads. We’re down to 45 minutes. They say they’ll take my four sets of stitches out on the next visit. It’s a completely different nurse on the third visit and she bottles it on the stitches. To be fair, if you’re not confident with it, I don’t want you down there with a stitch ripper and tweezers. If I get my dynamic duo back next visit, then they’ll take them out. Failing that, I’ve a clinic appointment with the surgeon the following day and they can go then.

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That’s where they took out the intramedullary nail.

My first visit to physiotherapy gets me prodded and poked a bit, and I get some exercises to build up mobility in my ankle. I’m not using crutches in the house any more, and then I’m getting up and down stairs without crutches and then I’m going up the stairs with a reciprocal gait (still leading with the bad leg on the way down). At my next visit, they have me working like a (lame) mule. Damn them, they can look right into me and see the bit that wants their approval, and they exploit it  It’s like I’m caught in some strange, therapeutic Stockholm syndrome. It works, mind you. The next day I walk into Bingley and back. It’s a 1km loop – it takes me 50 minutes. My ribs are aching from using crutches for so long. It’s a massive thing, though, a huge weight off my mind. If I can get to Bingley then I’m on my way back to independence. A small triumph but a triumph nonetheless.