My experience of spinal cord injury
1.THE ACCIDENT
Its approx 7.30 am, is a cold, wet and windy November morning and I am cycling through Greenwich park on my usually route to work. I am a physiotherapist working with a community stroke team in East London. I have a student currently working with me. Otherwise it is a typical Friday.
As I reach the main hill going through the park I start my decent... There is a queue of traffic all the way up the hill which is unusual. I pull out to avoid the traffic – there is no room between the cars and the ‘pavement’. I get half way down the hill and a car at the bottom is indicating to pull out, Again; unusual. It eventually pulls out, possibly to do a 3 point turn. I apply my breaks. I think it will be a miracle if I miss this!
The next thing I am aware of is the black underside of the car. I am stuck underneath a car, head pushed to one side. I know my neck is damaged. I can feel pins and needles in my arms and legs. What can I move? Legs? No. Arms? No. Shoulders? A bit. My breathing is shallow. A cry comes out from a passing driver ‘are you ok?’ My physiotherapist brain starts clicking in...I know what the damage is. The answer is probably no. But I ‘shout’ as loudly as I can: ”Yes – I will be alright!” (Really?!)
Police arrive and then the ambulance soon after. Remarkably I am not in pain, but the paramedics insert a line for pain killers. They take my basic observations. I’m still concerned about my breathing. Are my oxygen levels ok? Yes, comes the reply. I hope so!
I am, of course, still trapped underneath the car. The fire engine arrives and I overhear conversation regarding how to remove me from underneath it. A couple of options are explored. Please do not slide me out I think...it’s my neck that’s broken and moving me would only make it worse and there is no room to get a spinal board in. The car is (eventually) hydraulically lifted off me. I am put into a spinal board and then transferred to the ambulance.
At my request (knowing the clear spinal pathway at the Royal London Hospital, Whitechapel having been working there a few weeks ago) I request transfer there. I am blue lighted in the ambulance - no helicopter ride for me - too windy apparently! Calls are made to my parents who have to cancel their trip to Ireland and I am eager to let my student know I won’t be in! The paramedic seems to think this is slightly over zealous. I see the reflection of the blue lights as we go through the Rotherhithe tunnel. This is surreal in the extreme.
2.RESUSCITATION
I arrive into A+E resus and am greeted by a team of nurses and more doctors. Further tests are done. Including muscle strength – I seem to have good right leg activity. A close physio friend is called and comes to visit me from the ward, she is visibly upset. Each time I see this reaction I know things probably won’t be ‘ok’, whatever I keep telling myself! My parents and brother arrive. I am sent off for CTs and X-rays. It is confirmed I have a C4 burst fracture with spinal cord involvement. That means that the 4th bone in my neck is squashed and pushing on my spinal cord the important part of the nerves that carries information from the brain to the muscles. I know this is serious. Recovery may or may not happen and to either a greater or lesser extent. At this stage who knows?
I am sent for surgery. By 1pm I am being prepped. I have been catherterised. 2 consultants are called to surgery – people I was working with 4 weeks ago and the SHO from the ward does the final medical exams. I’m given the general anaesthetic...the next thing I know I emerge from a dreamy world with a slight feeling of elation and relief...for a brief moment I don’t have any pins and needles or discomfort or pain: ‘bliss’. I do a quick ‘body scan’, and think ‘oh no - there they are’, my heart sinks a little.
I see my family and a friend by my bedside. 2 physios come and meet me, these were my senior colleagues on my last rotation. They have completed referrals to spinal injury units. This has taken up most of their day today and it is now late in the evening, 7pm. However this is good news; the sooner I am on the list, sooner I can have further rehabilitation, and this is exactly what I will need!
3. ACUTE WARD
I am transferred to the ward. Amidst discussions about whether I should go to ITU end up on the ward. A physio comes to review me and do some chest physio to help with my breathing. She is new to this and visibly worried. It’s a bit messy though as up comes up my orange juice from this morning! Fear sweeps through me as I can barely swallow at the moment and I am worried I will choke and breathe some in and inadvertently give myself breathing complications, which would NOT be good.
I sleep on and off, broken only by the gurgling of other patients on the ward – some have tracheotomies (a tube in their neck through we they can breathe) and their phlegm makes it create this noise. If I was working I would go along and help out but I can’t. I know I need regular position change as there is a risk pressure can build up and damage my skin, plus it gets uncomfortable being stuck in one position. However, I can’t use the bell at all as my hands don’t work – this is a pressure switch but is impossible for me to push. I wait for a nurse to come and sort it out then raise my voice as much as I can to ask if I can be re- positioned. I also get disturbed by the monitors bleeping. This is often because my oxygen levels are dropping; I try and take a deep breath. This seems to solve it as the beeping stops. Until the next time. The cycle continues till morning.
Mum arrives in and its breakfast time. The nurse feeds me some yoghurt or porridge. I am still petrified of aspirating fluid into my lungs! I can barely manage to eat but know that I need to. I’ve been prescribed oral painkillers, as I have never been any good at swallowing tablets....I discuss my physical limitations with mum. I tell her as long as I get the use of my hands back that it will be much better.
Later in the morning a crew of physio friends come in. Along come CDs, a DVD player and teddies- a giraffe and a picture of a friend who went off to Hong Kong yesterday morning. I am delighted to see everyone. If a little overwhelmed by the generosity; ‘how will I ever repay it?’
Around midday I have some physio – more work on my breathing – it’s great. It feels so good to take deep breaths! I also have to have a very detailed assessment called an ASIA chart – lots of prodding and trying to move. However being pocked with a sharp neuro-tip when your neurological system is in turmoil is NOT nice. If fact it hurts. I have abnormal sensation throughout. Movement is not great either – in fact it is worse than yesterday. But I know this can happen as part of ‘spinal shock’.
By the evening I am having raging spasms in both of my legs. These are incredibly uncomfortable, even painful. I am prescribed some medications to help calm them down but they don’t take effect for a while. This is miserable. I think how am I going to cope if this does ever improve? I think of patients I have treated, how they have had severe spasms and how uncomfortable and traumatic it must have been for them. Losing control of your body like this is dreadful – some kind of horror story.
Morning comes and the spasms have been relieved. Mum arrives. It’s snowing apparently! And in normal circumstance I would be outside making a snow ball or organising a trip to the park with friends. Not so today. Instead the ward routine begins wash, dress (into a glamorous hospital gown) then breakfast all of which I am unable to do for myself.
We have had some responses from the spinal units. Stoke Mandevile may have a bed. And then not. And then Stanmore does. Each option poses a new set of considerations – can my parents commute? or do they need to find somewhere to stay? How close is it to friends? Eventually plans are made and I am due to transfer to Stanmore tomorrow.
Later on I go off to X-ray – accompanied by 2 friends. We sing songs together keep up morale and possibly avoid talking! It is a relief. They bring comfort. Other friends arrive and say not to worry about the future but to take one day at a time, good words. Some friends go quiet – clearly shocked and stand at the end of the bed – looking uncomfortable. I think, just talk to me normally, please! I’m still here and I’m still me!
The next day comes around, I am going to the spinal unit. I am given a whole ‘makeover’ – including hair wash and blow dry! There is a big commotion as I leave the ward an old patient of mine comes to see me and wishes me all the best. Another patient’s wife comes, through her tears tells me I will be fine as I am so determined. She thanks me for working with her husband to help his recovery.
It is surreal: the tables have been turned.
4. REHABILITATION
I am transferred to the ambulance – my parents accompany me. Off I go – to rehab! I end up feeling really sick so the lights are put on and we arrive shortly after.
I arrive and am taken to what will be my ward bay for the next 10 weeks (shorter than the predicted 16 weeks). I’m transferred to my bed. There are 3 other beds – none of which are currently occupied. To my relief the call bell is a flat, easily pushed one but later on that evening changes are made and I am given a bell which I can either blow into or breathe in through and this will alert he nurses. Still a bit tricky but I manage it. In some ways this is about survival, then about rehabilitation.
I have another assessment – the ASIA charting – this takes a while. Nothing has changed either. The next week or so flies by. I am introduced to the nuts and bolts of a rehabilitation ward. My daily routine consists of: breakfast at 6.30, ward round at 7-7.30 am, wash and dress at 8-9am. Then either Physiotherapy (PT) or Occupational Therapy (OT), lunch, visitors, PT/OT/activity, visitors, dinner, visitors, and lights dimmed at around 10am. I’m exhausted from riding the roller coaster. I am determined to get better and I know there are a huge number of people supporting me and and praying for me to get better too.
The first turning point is being assessed for an electric wheelchair much to my delight! Yes, delight I say, this chair means mobility and freedom. I can go to the café with friends and family and later on by myself. I am given splint to keep them in good position while waiting for muscle activity to return – if it does. I am also given an electrical stimulator to help work the muscles in my wrists and hands and of course some bed exercises – mind you most things I do now are ‘exercise’!
Daily there seems to be a new muscle or something else I am able to do for myself again. Whether it is picking up a pen, starting to write, feeding myself, tapping out my first text message. A few weeks later I try standing with my physio who is up for a having challenging patient and is persuaded that this is a good place to start – not sitting balance! I promptly faint. Oops! But I’m glad she’s up for the challenge.
Soon it is Christmas and I’m made to go to a Christmas party. But I just feel sad. I look round the room – we all sit in our wheelchairs. What is there to be happy about? None of us expected this?! It all feels somewhat trite – superficial. What will l address our DEESIRE to WALK?? I know for some this will not be possible.
However, before I know it I’m doing walking practice with a frame, then by the time New Year has come I’m walking with a stick in the thinly laid snow outside. This is not the normal speed of recovery even my PT and OT say so but I am thankful for it all the more and even more determined to get even more function back!
Whilst I am on the ward one day I am met by a lawyer about compensation. I’ve never formally spoken to one before. This all feels a little premature and I feel vulnerable. I know there will be a court case. I know I need to give a statement. But I also know this is all very important. Information needs to be accurate. I do my best recalling events. I also meet with a social worker who goes through benefits form for disabled living allowance. Disabled. What? My mind struggles with this word. I don’t want a label. I am me.
I work with my rehab support assistant through a booklet about my condition – it is educational and practical information about what spinal cord injury is and goes through things like bowel regimes, bladder management; things previously taken for granted have become an object of discussion, of management.
Before long I am having a discharge meeting. These multidisciplinary meetings which were familiar to me in my job have become an odd, alien like experience being the focus of goals and plans is not what I am used to. I speak to my consultant before I leave… will I be able to run again. I see her face…clearly walking is the target. Running has not been contemplated. I am frustrated but determined – in the same way when my science teacher said I couldn’t get an A* at GCSE. The gauntlet has been laid.
5. HOME
Soon I am discharged home. Then the hard work REALLY begins…! Adjusting, grieving, attending appointments, filing in forms, going to the gym. It is all too much sometimes. Feelings often overwhelm, often during the late night hours. Comfort does not come. I wake each morning with the same limitations.
I do however start to get stronger and less tired and my thoughts turn to work. Will I be able to do it? I do have a lot of things I can still do but looking after patients again…
6. WORK
I am determined given my ability to get back to work as soon as possible. By April I am starting some admin work on reduced hours. I think most people look at me as if I’m an alien! I am certainly keen! The crunch problem is can I work again as physio? Competencies are drawn up. I try and achieve some of them but struggle. I up my hours to full days. I end up working back on the ward where I spent my acute phase. Memories flood back. I can see there are many aspects of my job I can’t fulfil. But I determinedly try and make things work. However, some days I am just so tired.
After 4 months pass I decide to have a career break and explore other options. I am told I cannot be a neurophysio – the ultimate sting. Maybe academia may hold a place for me.
7. COMPENSATION
The July after the accident I am pulled into court as a witness to the accident. Witness? I think really, I am the victim. The CPS unfortunately do not seem adequately prepared and nor do they prep me. I am hauled across coals by the barrister who in total lack of sympathy and with totally incorrect information accused me of being negligent. Or being irresponsible. Yet the car driver cannot say that they check their blind spot. I am aghast. I colour to a greyish white and the magistrate allows me to sit in the box. This is like some TV drama. Not my life. I never asked for this.
I leave the court. Some time passes and eventually the case is settled. The crown did not win I am informed. However the insurance company will pay out – probably to avoid it going to a civil court. In a month my solicitor’s case manager meets with me and notes down all my problems. This is taken to the insurance company. They offer a price. I do not know how I am supposed to decide if this is worthwhile or not. I am living with a long term health condition caused by the driver. I will have early onset osteoarthritic changes – definitely in my neck – if not elsewhere. I cannot feel things as I used to be able to. I have pain daily. I have spasms in my arms and legs and stiffness in muscles. I have lost the ability to do the job that I loved. How do you put a price on all of that?
A settlement is reached and we settle. In record time (within almost a year of the accident taking place). I am thankful for that at least.
Now the rest of my life can begin.
8. NOW
I have now been able to rebuild much of my life. I am now working full time. I have a MSc degree and am working towards a PhD. I am lecturing also to undergraduate physiotherapists. I have just bought my own flat and having completed a 43 mile bike ride last year I have now entered my first ever sprint triathlon.
There is life beyond trauma!
