Walking on water

As I said, its not all doom and gloom. Being run over by a truck means you get a personal trainer for £2.80 an hour. With a qualification in sports rehab and remediation. And a nice Scottish name. Today it was my first real session down at the gym. And after the session, I finally got into the pool.

First challenge. Getting undressed and changed and then hauling my gear into an overhead locker - a few steps away from the disabled changing area. Had to take each item individually. Had a look at myself in the full length mirror. Mmm. Bit odd. My graft is bulky and strange. My right buttock has migrated down my leg and I still have massive bruising on my right thigh. Have to expose this lot to the public.

Hopped into the pool area. Waved at the life guard. He gave me some weird green tube that acts as a flotation device. And then I was in. Was easy to slip into the pool. Left my crutches by the ladder. And then I walked. Actually I walked in the water, not on it, but it felt pretty miraculous. Walking without crutches. And the deeper the water, the easier it became. I walked two lengths, and then tried a swim. Extraordinary.

Managed a couple of lengths breaststroke with almost no pain at all. OK - I was a lot slower than I used to be. And two lengths is fairly minimal. But I was swimming... A few more exercises and then it was time to get out. No point in overdoing it. And its cold when you aren't racing up and down.

Getting out was a breeze. This was unexpected. I had been offered the hoist.... And then the last challenge. Getting everything back out of the locker and into the changing room - item by item - while wet and cold. There's a design fault here somewhere.... I'm booked in with the personal trainer next Tuesday at 3pm. And I'm actually looking forward to it...

Operation No. 4

Back to the consultant. A lift there by a kind friend. Patient transport was full. X-ray first. (I asked the technician to colour in any hole he noticed in the x-rays). Then a short wait and in to see the miracle maker.

But it was too much to hope for. The hole was still there. And the technician hadnt't helped me out (no Photoshop in the RIE it seems). My tibia is 'lazy'. And, as it hasn't healed, it will have to be 'encouraged'. This will be done by replacing the current nail (from my ankle to my knee) with a slightly bigger one. When the new nail is pushed through, it results in a kind of bone graft - by pushing tiny fragments of bone through to the hole which then activates healing. In essence the operation aggravates the site and gives it a boot up the proverbial.... We hope.

It may not be successful, in which case we try again, with another nail replacement three months later.

The operation will take two hours and I should only be in hospital overnight, assuming everything goes well. I should take around a week to 'recover' and so I won't be knocked back to the beginning. I have to keep on with the physio and the moon boot stays. I asked not to go back to the orthopedic trauma ward. But there are no guarantees - it all depends where a bed can be found...

The operation is slightly complicated by my free flap (skin graft). My flap is fed by an artery, which may be very close to the screws holding the nail in. To undo the screws near the artery means care is required. If the artery is damaged, my skin graft is at risk. (although it now has other blood supplies). So a letter is being fired off to my plastics consultant to find out where the artery is.

God, I hope he can remember. I hope he wrote it down! The artery can be traced with a doppler if all else fails. And my consultant is a modest genius - he will not get it wrong.

So now its a waiting game for the appointment letter. My case is marked urgent. This means I should only have to wait 4 - 6 weeks. Given that this is operation No. 4. my consultant has said he wont bother with a preoperative clinic appointment. I've been in so many times I practically run the place. And it would only mean more hassles with patient transport.

So to the big question. How do I feel? Strange really. Not as I expected. Not hysterical. Not furious. Not desperate. Not anxious.

Just flat. And tired. Tired of the pain which continues to get worse although at least I know the root cause... Tired of telling the same story. Tired of being upbeat. Tired of thinking I should do valuable things with my time and not doing them. Tired of relying on other people. Tired of being tired....

But its not all doom and gloom. Today my ambulance crew included the fabulous Ali. Ali is a fairly recent recruit - around 18 months into the job. And she's wanted to do this work for years. And she starts with the emergency crews in May. She bounced up the stairs, met me with a cheery smile, told me how much she enjoyed her job and beamed all the way to the hospital and back. So much smiling. So much happiness! I can't remember the last time I met someone so genuinely upbeat. I might have a hole in my tibia, but I get to meet people like Ali.. And not many people get that happy opportunity...

Stan and his wife

Stan carries a picture of his wife in his wallet. He has always done so. For as long as he can remember. The picture was taken in 1944. Stan's wife is beautiful in the photo. The photo is protected in a clear plastic bag. Its the second one. The first was lost in Spain when Stan's wallet was stolen. They go abroad twice a year on holiday. They were evacuated from Croatia during the Bosnian crisis. Stan and his wife have been married for over 60 years. They met in the war at a RAF base in England. They are devoted to each other.

Stan and his wife have lived in the same house for over 40 years. It was new when they moved in. Until his wife's fall, they went out every day in the car: to Portobello or Arthurs Seat for a walk. They took tea in a flask. Stan's wife suffers from anxiety. This is caused, she thinks, by her experience of the war. Bombed night after night. After a while her mother didn't wait for the sound of the air raid sirens. She just took the children to the shelter in the evening. And there they slept. Terrified. Around 70 years later Stan's wife was nervous of her hospital appointment because of those air raids.

Stan's wife was the last patient on the ambulance list. The ambulance crew were in the house for quite some time. Stan's wife wasn't ready and she was nervous about travelling without Stan. So Stan came too. He was told he would have to find his own way back if the ambulance was full later. Stan's wife was wearing a nightie over her trousers, and a navy blue coat buttoned up tight. She had a soft neck brace and one arm in a sling. She was awfully pale. However, she survived her appointment and wasn't kept in. Come back in another three weeks they said.

I guess I wont see them again. 800 patients are collected each day in Edinburgh for their appointments. So the chances are slim. But I was very struck by Stan and his photo. Over 60 years. How beautiful is that?

Four Months

Four months on. time for an update.
I have just started my exercise referral. In essence this means I get to use the local gym/pool for £2.80 a time. The referral comes from my physiotherapist. Once again, though, I stumbled onto the opportunity by accident. Nobody told me about it. I just wandered into the gym and asked what was available. So this morning I had my first session. With a Fitness Instructor. Was more difficult than the physio as the minimum weights in most of the machines are 5kgs - rather than the 2kgs I'm used to. This means I have to be careful not to overdo it or injure myself inadvertently.

And next week I will use the pool. Getting in will be alright. Getting out will be a great deal trickier. There is a hoist. but I'm damned if I'm being lifted out of the pool - at least not with the lights on! My visits to physio will reduce to twice a week from early April - supplemented by the these gym and pool sessions. This must be progress.

I am still on my crutches and still not fully weight bearing. My ankle movement is still limited although my knee is almost 100%. 'Walking' round the block is exhausting. The local shop, though, is manageable. I am still eligible for patient transport and still haven't managed to use a bus. I think, though, I can now walk to my GP's surgery - just... My wheelchair can probably be returned to the Red Cross - perhaps after I have seen my consultant next week.

I have had a letter from my employer informing me about half pay. This is frightening - and very complicated. Three conversations with patient HR staff and I still only vaguely understand it. Sick pay is worked out on a calender year - but also over four years. (This means that as well as my injury leaving a physical and perhaps mental legacy, my time off work now will continue to have an impact over several years.) And weekends and public holidays count as sick days on continuous sick leave.

I have to start sorting out my finances. As I will go back to work on a 'phased return' I will almost certainly run out of full sick pay. This means that future sick days will be paid at half rate. A future operation (or two) for example. A stomach upset or the flu. Stress. Or a setback with my injury. A drop in income is guaranteed. So now I am investigating my finances, reducing my mortgage (thank god for the ridiculously low interest rates), raiding my savings to pay off my loan, and binning my credit card. Reduced mobility tends to cut down spending on some things - but it increases on others - particularly transport. Taxis do not come cheap.

I am as skinny as ever. 50kgs at last count. This is largely to do with lost muscle tone. But cooking also remains a drag. Eating in the kitchen isn't much fun - although the radio helps. I am practically a local down at Ambridge... I have less assistance now that I'm four months on. More independence is required. I can eat at the pub next door. But its expensive and often full.

My mood still swings and I have almost no tolerance for what I perceive as bullshit. I have been badly behaved in a local community group meeting and stupidly upset by a canceled lunch appointment. I am visibly shaken when I see a policeman on the street, and passing trucks are too big, too close and too loud. Listening to a House of Lords debate on cycle safety the other night was odd. Reading about Hillsborough (20 years ago in May) also very unsettling. I assume this will dissipate over time - but its worrying nonetheless. However, my concentration has improved. I am ploughing through books and spending less time on the Internet.

Here in Edinburgh spring has arrived. Its hard to be miserable when the sparrows are singing on the skylight and my flat is filled with sunshine. Healing requires a focus on the present - not the future or the past. One breath at a time. One step at a time. Its so easy to write...

Lost in transit

Its Monday. Its physio. My appointment is at 10am. This means I have to be ready at 8.30am just in case (last week the ambulance came dead on 8.30 for a 9.30 appointment). I have breakfast and wait. And wait. And wait. at 10 I try to phone Patient Transport. Cant get through. At 10.15 I phone the physio department to say I will be late. I try Patient Transport again. And again. And again.

In the meantime I try to call St Johns. I have an appointment in April and I need to arrange patient transport. But the secretary's number doesn't work. I try switchboard. Seems the secretary's phone has been put on the wrong setting. There is no way of contacting her. I call someone in the outpatient department. Not their responsibility apparently. They tell me to call Patient Transport direct.

At 11 I get a call from Physio. The person is extremely apologetic. Seems someone forgot to book my transport. My appointment is lost and I have wasted two and a half hours waiting. And money on all the phone calls.

I ring Patient Transport again. Astonishing. Get through. Try to book the trip to St Johns. No. Its the rule. The hospital has to make the booking if its less than six months since I saw them the last time. Outrageous. But I cant get through to the correct person in the hospital. I plead. Pleading doesn't work. I ring the switchboard. Ask if there is any way of contacting the secretary. No. What about email? I am given an address. I have no idea if hospital staff read their emails. Most of the systems still appear to be on paper. I send her an email anyway.

I don't like complaining about the NHS. People work hard. And they care. Resources are stretched. But I am a good patient. I turn up on time. I do my physio. I am always ready when the ambulance comes. I fulfill my side of the contract. But today's antics are more akin to a 19th century French farce than a state of the art health system. Of course it is probably just coincidence that the booking wasn't made and the phone was on the wrong setting. The systems are set up tp produce efficient positive outcomes. But I made around 15 phone calls this morning. With nothing to show for it but disappointment and frustration.

I did, though, get a nice letter about my prescription payments - warning me that my pre paid prescription card was about to expire. It remains to be seen how easy it is to renew it! Going on my experience with community pharmacies to date, it should be a piece of cake...

A legacy for Ward 18

Most of us want a legacy of some sort. Something positive to be remembered by. Its not necessarily altruistic. We want to be seen to be doing good for others. It makes us feel warm inside. Some people leave their bodies to medical science (cheaper than a funeral too...). Others pay for a park bench (sometimes situated in the oddest of places...). Still others leave money to charities. Cat and dog homes are popular. Cancer research and hospices too. Conservation charities do well. Church roofs used to be the in thing. And often the people who have the least to give donate the highest proportion of their wealth.

There's been a lot of mention of this in the media recently. Millionaire and billionaire 'philanthropists' who donate large sums to charity with plenty of media coverage but don't pay tax in this country. There's a wonderful irony in this. For their tax bills would probably be considerably higher than their donations. And with more tax coming in, would there be less need for the charitable donations...?

So where do I fit into this? I pay direct debits to three well known charities. I have a charity credit card. Every time I buy something, a little brown bird benefits. I make one off contributions to disaster funds: earthquakes, tsunamis, illegal wars. And then suffer the interminable phone calls for weeks afterwards asking for more. I could off course make more and higher contributions. But sometimes it feels strange to be funding things - where the perpetrator of the loss or suffering should really pick up the costs. Gaza being a prime example. However, I digress.

Back in November I was in Ward 18 in St Johns Hospital, Livingstone. The standard of medical, nursing and 'hotel' services was outstanding. Staff coming in on their days off to decorate a Christmas tree. Time taken for patient hair washing. Fresh hot delicious food. A comforting chat in the dead of night. I genuinely didn't want to leave. I noticed, though, that the ward could have done with another commode. An extra one would save nurses time and effort, and increase the comfort of patients. So at Christmas I sent a card, offering to purchase one for the ward. It was a daft idea, but appealed somehow. What a legacy!

Yesterday I finally received a call from the Ward. Was I still interested in buying the commode? The nurse was a little embarrassed about the price. Someone is making a healthy profit out there. But the cost of the commode is less than a weekend trip to Barcelona, less than dinner for four at a Michelin star restaurant, less than a designer handbag. OK, perhaps the NHS should be picking up the tab. But it isn't. So I, with a generous contribution from my mother, will buy the commode. Its not clear yet whether there will be a plaque, but if so, we will need something appropriate with just the right amount of cheek. Entries on a postcard please...

The great escape

It was bound to happen sooner or later. Getting into my flat is always a bit tricky. Holding the door open and trying to hop in without jamming my fingers, or slipping on the rug. And every time there are two furry spectators, sitting just far enough away to be safe from my sticks. Waiting for a opportunity to head out themselves. Last night they finally made a bid for freedom.

It was around midnight. I'd been at the movies with a friend. I opened the door and the two furry creatures looked up, and then cool as cool things, strode out the door into the stairwell. Shit! I fumbled around, trying to screw up a bit of paper to entice them back in. (usually works a treat when getting them out of the living room). But I couldn't manage without letting go of the door. I propped the door open with my coat, hopped through to the kitchen, grabbed the cat food and scattered some cat biscuits in the hall. Betty, the little furry one, couldn't resist and strolled back in. But Gordito was sniffing the plants. Its a jungle out there. I shut the door and chased Betty into the kitchen. Then, armed with more biscuits I struggled back into the stairwell. Looked down. Gordito was two floors down scrutinising the neighbours' doormat. I called him. He ignored me.

Overheating and stressed I hopped downstairs with my crutches. Gordito started to pad upstairs. He passed me half way and found the biscuits I'd laid as bait outside the door. He's a greedy thing so he stopped to munch. I hopped back up and caught him. But I was unable to hold onto him, open the door, keep Betty in and hold my crutches at the same time. I sat down on the floor. Furious. But laughing. Thank goodness no one could see. Gordito ate more biscuits. Betty cried on the other side of the door. Sitting was easier though. I opened the door, threw some biscuits inside for Betty, shoved the fat one through and shut the door. Now they were inside and I was out - on the floor. It took me a few minutes of planning and a lot of manoeuvring to get back in safely. Once in I collapsed on the couch. They looked at my in puzzlement. And then Betty asked for more biscuits.

The next day, revenge was had. I didn't wake up until 11am (despite the incessant and increasingly desperate furry wrestling on my bed). The creatures had their breakfast three hours late. That'll learn them...

The definition of justice

Up until now most of my time since my truck incident has been spent interacting within the health system. I am patient and passenger, client and customer. All the people I deal with are there, directly or indirectly, to help me recover. Of course they have their own agendas. They have targets and timetables. They have systems and processes. There are policies and procedures - thousands of them. They have objectives and appraisals, supervision and exams. They have bosses and minions, students and professors. Sometimes they have dramas, other times its more humdrum. They have celebrations and personal tragedies.

Despite of and because of all of this I am making progress. I have come to understand the system, the systems within systems, the idiosyncrasies and madness, the friendliness and occasional heartlessness. And of course, I am now an integral part of the system - no patients - no medical teams - no passengers - no transport.

And just as I begin to understand the health system, I have to add in the justice system. It is the justice system that will determine any compensation for my injuries and associated suffering and losses. But this is a whole new ball game. Here my understanding stems only from the study of justice and philosophy. It comes from Rawls and Hume and Plato. Hypothetical veils of ignorance and Socratic conversations some two thousand years ago. The more recent occasional chat with a community policeman hasn't led to many insights.

My road to potential compensation is unlikely, though, to involve desultory conversation about justice as fairness or justice as doing no harm. Rather, it will involve the police, lawyers, insurance companies, the court system, independent medical checks, and god knows what else. Unlike the health system, not everyone will necessarily be 'on my side'. Because of course there is more than one party in my truck incident. And most frustrating of all, I wont be able to write about it.

You can challenge me on this if you like - but for some reason it feels inappropriate to write it down and 'publish' it. Not safe somehow. Not that there isn't a story in it - quite the opposite in fact. But it comes at a time when the role of the state is being questioned in relation to personal data. And a time when the balance between liberty and safety (from terrorist acts) is resulting in strange decisions. There is a loss of confidence by some communities in the institutions who are supposed to protect us and keep us safe.

So, if you want to hear how its going with me and the justice system, you'll have to drop in for a coffee, or take me for a cake. I'll tell you stories that will make the hairs on the nape of your neck stand on end. And when its all over, at least two years away as I understand, I'll give you my definition of justice, as it happened to me. Socrates, I imagine, will turn in his grave.

Overstepping the mark

Today was not good. Firstly I pulled the string on the bathroom light and it came off in my hands - leaving the light on. No idea at all how to fix this given that I cant climb up to have a look at the light or reach up to the switchboard and turn off the circuit. Crutches and ladders just aren't a happy combination.

Then collected in an 'ambulance car' for physio. Does this mean I've been promoted? Out of the three pick ups on route I am the only person who bothers to answer the door. What a waste of resources. Despite arriving on time, I then had to wait 15 minutes for my physio. And the session started with what I would call an aggressive (although necessary) invasion of my talis bone.

In essence my Physio presses her thumb hard into the front of my talis and then glides the bone a few millimetres at a time for several minutes. This is intensely painful - evidenced by the angry red mark which hangs around for ten minutes or so afterwards. Then further endurance required as I stand with my right foot on a low box and do 20 dreadful lunges. But worse was to come.

The other biodex machine. (Obviously this is not me in the picture although my expression was somewhat similar). This biodex is rather like a Wii. You stand on it, keep your feet firmly planted, the ground beneath you starts to move and then you shift your weight around to get a cursor into a box on the panel at eye level. I failed at my first go, and the Physio changed the settings. It was difficult and painful. My right foot has little flexibility let alone enough movement to withstand the motion of the plate. I suffered it for 2 minutes, keeping that cursor in the box with my right foot (pride and ego seem the only antidote to the pain). Wondered vaguely whether this was invented before computer games or was a torturous offshoot. Or something stemming from military hardwear perhaps?

Back at home the pain in my right ankle continued for the rest of the day. My lawyer came and went and still the pain was there. The pain could indicate a loosening of the screws in my ankle. Or it could be that we just overdid it. It is unusual though and handfuls of painkillers had no effect.

Missus Two Shoes

Friday 6th March. The day I get to don my right shoe. Over three months without wearing two shoes. Can you imagine? Unfortunately it wasn't a fancy shoe (my cheeky little Think ankle boots not quite orthotic enough..). But heh, it was a start. First problem - what to wear with it? When you are used to wearing only one shoe, and thus only one sock, all the socks in your collection mysteriously lose their partners. Turned my drawers upside looking for a matching pair of socks. No luck. Had to wear odd socks at physio - but no one bats an eyelid there. And, as usual with these frissons of excitement, they are held back to the last ten minutes of the physio session. And this time by the infamous biodex machine.

The biodex machine looks to all intents and purposes like an instrument of torture. I sat on it (not strapped in although most other people are to stop them cheating or falling off - depending on who you ask), my right thigh raised above my hips and my right foot resting on a metal plate out in front of me. Once my foot was safely strapped on, the machine started. In essence I got ten minutes of slowly increasing dorsi and planter movement. The gentle rocking motion was surprisingly pleasant. And I managed to get 38 degrees of movement before the pain became too much. And then finally, there can be no further diversions - I head for my second shoe.

It was tricky to get the shoe on despite the assistance of the very shy Norwegian physio student. I tried first with the sock but the shoe wouldn't fit. (All that trouble looking for a sock...) Then I tried with a light weight tubigrip. That worked although it looked a bit odd. Then I was up and standing in my two shoes - crutches ready. I took a few steps. It was very odd. My leg appeared to have shrunk a couple of inches and my right hip didn't quite know what to do. I also felt light - the moon boot must be at least a kilo if not more. I tried the leg press, and the exercise bike, with my two shoes. I was victorious (shorter mind..) but almost normal. Still have to wear the moon boot outside (just in case) but the boot is formally in the past when I'm at home. Now just have to get over my pride about wearing ancient trainers (I hate the sodding things!).

Just like riding a bike..

Another day... More physio... But this time I've been promoted: to the giant green gym ball: and, more importantly, to the exercise bike. The home physio has paid off. I now have 5 degrees of dorsi movement in my ankle (out of a possible 15). This has been achieved by sheer brute force: the full weight of my Physiotherapist when at the hospital: and my hauling it with a towel at home. And my reward? Getting on the exercise bike.

Strange. It hadn't occurred to me that my first 'ride' would be in the gym. I looked at the machine with suspicion. "You're not a real bike" I muttered. I'd always thought that people who exercised on these things were rather mad. What a pointless activity. But I guess safe from trucks - unless one manages to penetrate deep into the department from the madness of the car park. Imagine the headlines.. Anyway - back to the machine.

Since I am still only wearing one shoe I had to climb on and put my good shod foot into the left pedal loop, and then ease my gammy right one (in its multicoloured sock - nothing like a bit of attention seeking when you've got something to hide) into the right. The grey vinyl seat was remarkably uncomfortable. I complained about this - and then without further thought - started pedalling.

Well - it wasn't hard and I didn't go anywhere. No sounds of traffic and no trucks. Pedalled gently for a few minutes and then picked up a bit of speed. The idea is to strengthen my quads and get a cheeky dorsi stretch at the same time. After 5 minutes I was instructed to stop. Dismounted with the ease and confidence of an old hand.

The gym ball wasn't so easy. I had to sit on this without holding onto anything stable and then rock over my right ankle - more dorsi activity. Balance is tricky - mainly because my 'core' strength is limited. Lack of physical activity over the past few months has taken its toll. However I do get some dorsi movement, don't fall off and crucially, don't embarrass myself. The thrice daily sit ups have apparently paid off.

Then onto the leg press for some final stretches. and a bit more pain. Now that I have 5 degrees my world expands. Gym balls, exercise bikes, leg press machines (and on Friday will be wearing my right shoe for the first time). Soon, as my pal Kenny says, I'll be up for the dancin...

An army of health professionals

My first sick note expires this week. Time for a GP visit, and an OH (occupational health) assessment. My GP is situated just out of reach of crutch hobbling, but too close for a taxi (in my opinion anyway). The receptionist said it would be fine to renew my sick line through a phone appointment. Relying on this advice I duly made, and then had, the appointment. Sods law. The GP said no - she couldn't do the sick line without seeing me. This meant missing my deadline for work, (ie, having a few days off without a sick line) and having to coordinate an available appointment with my very kind and patient neighbours who would provide the transport. Two phone calls and several texts later we settled for Friday 6th March.

In the meantime, I had to get myself to the OH surgery this morning, handily located out at Liberton. The appointment letter comes with bus information - which is a good thing. But of course, I can't get to the bus stop yet never mind manage two buses. Luckily Handicabs was available - so £8 for the transport. It was bitterly cold when we arrived at the surgery. I followed the signs for the disabled entrance and headed up the ramp on my crutches. It started to rain. The door was locked. I rang the bell. Nothing. Rang again and again. Fingers frozen and turning blue at the tips. Eventually the door was opened and I was ushered in. I understand the door has to be locked for security reasons, and the staff were extremely apologetic. But its just another example of what people with mobility problems have to put up with.

I spoke with the OH doctor for around half an hour. We concluded that I was not fit to return to work - and would see him again in a couple of months time. Unfortunately he can not sign my sick line - thus another visit to another health professional required (see above). My GP does not get a copy of his letter to my employer unless I make one available. And yet its my GP who is signing me off. There's a method in all this madness - mainly independent specialist advice for myself and my employer - but it makes for a complicated life.

I am now in the care of one GP practice, one OH doctor, two physiotherapists (a junior and a senior), one psychologist, one consultant at the RIE and one consultant at St Johns in Livingstone. Oh - and the community pharmacist and the pharmacy delivery boy. In theory I have an occupational therapist although they have never made contact. I have three transport contacts: Lothian Patient Transport, Handicabs and the local minicab company. I also have a lawyer (in relation to a potential compensation claim), a boss and an HR contact at my work. It is my job to coordinate the information and appointments between all of these professionals and colleagues. I spend half my life on my mobile phone, the other half at appointments - its really not that dissimilar to being at work....