cover missing

Contents

About the Book

About the Author

Title Page

Dedication

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Resources

Acknowledgements

Copyright

About the Book

Tim Rushby-Smith is six foot two and highly active, with a love of high places and the great outdoors. Three years ago, with a booming garden design and landscaping business and his wife five months pregnant with their first child, Tim fell six metres out of a tree and broke his back, confining him to a wheelchair.

As he came to terms with his injury, treatment and rehabilitation, Tim faced an entirely new life, in which many of life’s simplest tasks suddenly became monumental challenges. This is Tim’s very human story of learning to live with disability, from overwhelming feelings of anger and despair, to learning how to face the future head on, and watching his daughter take her first steps.

Emotional but never self-pitying, this is his unflinchingly honest account of how he built a new life; as a man, a husband and a father.

Tim Rushby-Smith worked as a landscape gardener before his accident. He now works as an artist and writer and lives in London with his wife Penny and their daughter.

About the Author

Tim Rushby-Smith lives in Hackney, London with his wife Penny and daughter Rosalie. He worked before as a landscape gardener before his accident. He now works as an artist and writer. He is involved with various charities, attempting to help both those with a disability and also their families and friends. Tim regularly visits Stoke Mandeville Spinal Injuries Centre in Buckinghamshire, where he was treated.

Looking Up

A HUMOROUS and UNFLINCHING account of learning to LIVE AGAIN with SUDDEN DISABILITY

Tim Rushby-Smith

For Penny and Rosalie

1

WHERE TO BEGIN? Well, that’s easy. I am lying on the roof of an old garage at the bottom of a garden. I am under a tree, looking up at the branches and the grey sky beyond, and I am confused as to what has just happened. I was working in the tree, six metres up and attached by rope and harness, preparing to come down after 45 minutes of climbing and pruning. Now I am on my back on a garage roof, and I can’t feel my legs. So much for ‘slow motion’ – the accident is over before I even begin to work out what is happening.

I shout out to my wife, Penny, who is in the garden calling to me, and trying to get through a tangle of shrubs to see me. She is five months pregnant. Out of the corner of her eye, she has just seen me fall and, until hearing my voice, had presumed me dead. It is 1 April 2005, I am 36 years old, and suddenly my life has concertinaed so that all the happy times and periods of gentle contentedness have disappeared into the folds, and my history has become 36 years of stumbling from catastrophe to disaster, as if I am locked into a very inefficient subconscious suicide pact.

There is a voice in my head. It is my voice, and it is saying, ‘Well, you’ve really gone and fucked it this time.’

Outside, my voice is saying, ‘Penny, I’m sorry. I’m sorry. Pen, Pen, it hurts. I’m sorry. It hurts so much.’

Now, what’s weird here is that I remember saying ‘it hurts’, but somehow I have no recollection of the pain. I remember thinking, ‘it’s going to hurt any minute now’, and trying to put the pain off for as long as possible. I also remember howling like a banshee, so it must have hurt, but all I can remember is my legs feeling as if they are in a ‘tuck’ position, and I am unable to move them. I’m sure I can feel them, but they refuse to respond.

The ‘thwup thwup’ of the helicopter blades of the air ambulance cuts through the sound of vigorous spring birdsong that Penny has been getting me to concentrate on to keep me distracted. She has just scaled a six-foot-high fence into the adjoining garden, and is standing on their compost heap in order to be able to see me.

‘Can you hear the birds? It sounds like a robin. Isn’t it a beautiful spring morning?’

‘I’m so sorry, Pen! Aww it really hurts! I can’t feel my legs! Pen? Pen? I’m so sorry!’

‘It’s OK. It’s OK. The ambulance is on its way.’

Penny is terrified that I will lose consciousness, so she keeps up a constant line of inane conversation, which is helping her to keep her own panic at bay, that sense of facing something monumental – the moment when you know that the world is turning, and the events before you are totally out of your control. She keeps her focus, and every time I try and lift my head, she shouts at me to keep still, and changes the subject. She gets me to talk about Australia, where she is from, and where we were on holiday less than a week ago.

The first emergency service to arrive on the scene is the police. Penny explains that we are landscapers and that this is our client’s garden. She shows one of the officers where to climb over the fence that she has scaled in her pregnant state, and the policeman adds to my bewilderment by asking me for my name and address.

Within twenty minutes I am joined by a paramedic, who has very bravely climbed onto the roof (which is of dubious structural integrity and most likely made of asbestos), and she has answered my pleas by shooting me full of I don’t know what, but nor do I know much of anything now. The world drifts in and out of focus and the light filtered through the branches becomes brighter and more colourful, and voices around me swirl in and out, and I think: this is it, I’m dying. I’m dying. Except I’m not just thinking it, and the paramedic laughs and she says, ‘You’re not dying,’ which comes as something of a relief, and so begins a two-week period under the influence of very strong drugs.

As I drift in and out of consciousness, I am put onto a backboard and someone tells me that they have to move me, and that they are sorry but it is going to hurt. I hear a voice inside my head telling me to scream, so I do, but it feels as if I am doing so merely to be polite and do what is expected of me, rather than because of any pain. I glimpse my brother among the various faces that drift past, and I have a very vague sense of confusion as to why he’s here. I lose consciousness, and wake up in a hospital bed with a neck brace on.

From the outside, Penny has given me a more reliable account of what happens during this time. The paramedics arrive on the scene with an air of calm and friendly efficiency. The policeman is shooed back down into the garden, and after a brief discussion, the lightest paramedic climbs onto the roof so that she can assess me. Some firemen appear in the adjoining garden. As they are cutting off my clothes and harness, and Penny starts shivering with cold, fear and adrenalin, a familiar face appears over the shed roof. It is my brother, Chris. Penny is so confused at seeing him there that she forgets to ask how or why. It turns out that the neighbour is the mother of a good friend of Chris’s, who knew that we were doing some work next door, and she telephoned him straight away. His presence is a huge help in preventing Penny from feeling alone. She also asks him if he could phone our mother, as the very thought of having to break the news makes Penny feel sick. He graciously agrees, but it is obvious from the look of concern on his face that he knows that it is going to be a terrible call to have to make.

I am lifted off the roof by the fire brigade using a sort of emergency platform that is extended from the back of a fire engine and delicately threaded through the branches of the trees. All in all, there are about eighteen people involved, and the whole neighbourhood has come out to watch. The London Air Ambulance lands in a nearby park, and I am taken first by the platform into a car park, and then on by ambulance to the entrance to the park, before being taken to the helicopter by gurney along a very bumpy path (more screaming, apparently), all the time accompanied by Penny. As we near the air ambulance, there is a man and a boy with a video camera, filming our approach. Penny shouts at them, and the paramedics ask them more politely to put the camera away. No doubt they are hoping to sell the clips to the world’s media, and are disappointed that it’s all just for some bloke who’s fallen out of a tree.

Although it is against medical advice for Penny to travel in an unpressurised cabin during pregnancy, the choice is an hour by road or four minutes in the air, of which only about 30 seconds is at an ‘unadvisable altitude’ and the air ambulance crew can see that there is no way that she is going to be left behind, so they take her along too. I am carefully loaded on board, the various monitors and masks attached, bags of equipment loaded, Penny loaded and joined by two paramedics. They are ready to go when Penny spots a bumblebee that has landed on one of the paramedics’ bags and is coming along for the ride. She points out the stowaway, and the pilot immediately calls a halt to take-off while one of the paramedics lifts the bag out before ushering the bumblebee away, amid jokes about bees flying onto noses of helicopter pilots. The remaining passengers are secured, doors closed and we are all flown across London to the Royal London Hospital in Whitechapel.

Once there, I am taken to the emergency room, where I am greeted by a group of about ten medics in scrubs and masks. Penny is ushered out to the waiting room to be quizzed further by the determined PC from the garden, and to fill out various hospital admission forms. Everyone comments on the date: 1 April.

Eventually Chris arrives, and Penny excuses herself to make her first call. Instinctively she wants to have a friend there as well as my family, so it is our close friend Graham who has his lunch interrupted, immediately senses the seriousness of the situation, and leaves work at once for the hospital. Penny is invited in to see me again, as the assessments have been completed. This time I look like something from a science-fiction film. I am naked on a bed, surrounded entirely by an inflatable transparent plastic bubble, with only my head poking out at one end.

One of the medical team explains: ‘We’re going to take an MRI scan to assess the damage, but we suspect a spinal-cord injury. In the meantime we are giving him large doses of steroids to try and minimise the damage.’

Penny returns to the waiting room, where Chris hugs her as she begins to cry for the first time, sobbing, ‘I hate feeling this much out of control.’

My mother, Uli, arrives with my stepfather Eugene, followed soon after by Graham. They all pace the waiting room in a hot, stifling silence.

Eventually one of the doctors arrives. He is direct and serious, but comes across as open and approachable. At no time does he give them false hope as he reveals the results of the MRI scan.

‘It’s very serious. Tim has what looks like a complete severing of the spinal cord.’

He pauses, then, ‘He won’t walk again.’

Penny swears under her breath in an otherwise silent room. She can see my mother wiping tears away.

Less than four hours after my fall, the neck brace is removed and a young doctor comes in for the ‘give it to me straight, doc’ routine. He is very good, tells me I won’t walk again, and pats me self-consciously on the shoulder. I feel sorry for him, and almost apologise for putting him through all of this. It must be the large amounts of morphine, but I feel as if I am playing this part in a film, and I’m trying to impart the right amount of emotional gravitas, but it’s hard work, and I just want to yell ‘cut’ and take a break so I can work out my motivation.

I make upbeat comments to friends and family about life in a wheelchair, as if the adjustment will be effortless. Or rather, the film version of me says all these things. I cry some, but even this seems as if I am moved by the plight of someone else.

At one point in the afternoon, Penny joins my mother by the window, looking down at the courtyard below. She wants to tell her that she isn’t going anywhere, and that she is still going to love me, despite the massive changes that are evidently going to occur in our life together. In the end, all she can say is, ‘You know, I just love him so much.’ It is enough.

In the evening, Penny is joined at my bedside by one of the female paramedics. She unclips my silver necklace from round her neck where she put it for safekeeping, and says, ‘My shift has just ended and I’ve been wondering how you’re doing, big fella.’

Eventually everyone leaves, and I find myself lying flat on my back, able only to move my arms and swivel my head. I do a quick inventory. Absolutely nothing going on from the waist down. No movement in my legs, no sensation in my genitals. Now this is something that hasn’t occurred to me until this point, and there is a shock of realisation, although it, too, feels far removed, like a distant memory of something sad. Through the drug haze, I try and replay the events of the day. I struggle to explain what happened, what went wrong. The medication pulls me away from concentration and leaves me drifting.

Meanwhile, Penny has been thinking about the baby on and off all day, but she hasn’t felt much movement. She asks one of the nurses on the ward if there is anyone she could see. They suggest that she goes down to obstetrics or A & E, as it is now out of hours. Then one of the other nurses overhears, and ushers Penny to a neighbouring bed that is empty and pulls the curtain around. Penny’s blood pressure is fine and the nurse assures her that she can hear a tiny heartbeat. She tells the nurse how relieved she is. ‘We only had an ultrasound at the beginning of the week, where we saw the baby waving back at us on the screen. It was supposed to be me providing the big event of the year. Getting all the attention. And now,’ she rolls her eyes, ‘typical male, Tim goes and upstages me.’

She is offered a high-backed upholstered chair by my bedside to stay the night in, but she is so uncomfortable that at 11 p.m. she whispers goodnight, and goes home with our friend Neil, who is a consultant anaesthetist. Over the next few months he provides us with valued support and a bit of inside information that makes the medical world we have just become a part of less intimidating. Neil and his wife put Penny up so that she doesn’t have to go home, and they sit up until the early hours discussing the day, before Penny eventually drags herself up to bed, where she cries herself to sleep.

For me, the night is punctuated by ‘turning’. Turning takes the form of a group of three nurses rolling me over onto alternate sides in order to prevent pressure sores developing. Normally, if you lie in one position for a long time, you get discomfort in the form of cramp, or pins and needles. This is a signal to the brain, warning that the pressure on one spot is starving the skin and the epidermis of blood. The blood is needed to wash out the build-up of toxins, and to provide oxygen. No blood, and the cells in the area begin to break down, which can eventually lead to a pressure sore.

Although the nurses are very careful, the turning process is extremely painful, with hands grabbing at me from all sides as they try to keep my spine immobile while turning me over. Along with the shock and pain, my tears bring the added distress of visits from a nurse who insists on talking to me about God and ‘our Lord Jesus Christ’. My rabid atheism has certainly not been tamed by my situation. If I am to find ‘redemption’, it is not now, and certainly not by being preached to by someone who is clearly taking advantage of a captive audience.

The next day starts with tears, tea and Ready Brek through a straw, as I can barely turn my head, and my arm movements are heavily restricted by pain. I receive a visit from a professor. He is the head of the neurological team at the hospital, and the visit involves looking at X-rays, lots of sage chin-stroking and various minions hanging around like needy kids round the teacher in a primary-school playground.

The professor explains that he is going to operate on me on 6 April, so that he can have his own team working with him. He plans to insert a fixation in order to stabilise my spine.

And so, I drift in and out of lucidity, hear tales from nurses about previous patients with spinal injuries, people who had been told they would never walk again, who have come back to visit the ward walking (a miracle, of course).

Meanwhile, Penny has the awful telephone calls to make. Her parents are at a wedding in Melbourne, but once Penny’s brother has contacted them, they leave straight away to return home to Sydney. My father eventually gets a signal on his telephone in a remote area of France where he is on holiday with his wife Margaret, only to find that he has seventeen missed calls from Chris. Having tried unsuccessfully to return the calls, he telephones me on my mobile to see if I know what the emergency is, and so I get to tell him myself. I’m not even sure exactly what I tell him, as I am drifting in and out of lucidity, but I manage to get the main details across.

Penny spends much of the day on the fire escape to get a signal and some privacy to make all the difficult calls. She quickly learns to get across early that I am alive, but ‘seriously injured’.

I receive visits from friends and family. Penny gets text messages all day. They offer help and comfort in whatever way they can. Friends buy me an electric fan, as there is a mini-heatwave and the ward is fiercely hot. I’m given a digital radio as well but, most valuable of all, I get a seemingly constant stream of visitors. I lie in bed holding court, naked except for a white sheet that just accentuates my Australian tan, my feet even bearing the white lines earned by living for a month in flip-flops.

Through the confusion of shock and medication I play my role with élan, all brave face and witty remarks, but I’m drifting, on the point of drowning, and when I do come up for air all I can do is cry.

Things get a bit disjointed from here. I have surgery to stabilise my spine with a titanium fixation on 6 April. The surgery takes around six hours. Penny waits at home for several hours with friends and family, and then begins to phone the hospital at regular intervals. Unable to get any news, she phones Neil, who rings the hospital and finds out that I have been moved to recovery. Penny comes to the hospital, and waits for several more hours in the patient lounge, watching random television: a BBC special about Frank Gardner, the Middle East correspondent who suffered a spinal-cord injury after being shot in the back. The documentary includes footage of him walking in callipers at Stanmore spinal unit.

Eventually I come round and Penny is called as I am wheeled back to the ward. The surgery is described as having gone ‘pretty well’, although they couldn’t fully realign one of my vertebrae and had to leave it, as surgery had taken longer than expected and I was ‘losing too much blood’, according to the rather vague account that Penny receives from one of the junior members of the professor’s team, which includes a series of hand gestures to accompany the erudite explanation, ‘Well, it was like that, we’ve got it to there, but it should be like that.’ After a pause, he adds, ‘It’s complete.’

Without further explanation, he walks off.

Fortunately, Scott Cairns (the senior house officer) takes the time to get all the films out and explain to Penny and my mother how my spine has been ‘fixed’, and where the screws and rods have been inserted.

Meanwhile I am put on a patient-controlled analgesia (PCA) machine, where I get to press a button when it hurts and the machine administers a dose of morphine into my IV line. Yummy.

At first I am fairly out of it, and everything feels like it’s under control. The pain-management team visit me, like pushers with clipboards, and tell me that I can have as much medication as I need and that there is no reason why I should feel any pain. I speak into a borrowed Dictaphone a few times and I feel confident of the incisive perception of my observations. The following is a transcript: ‘. . . strange thoughts and ramblings. I’ve just thought of all these women standing around talking about a charity for fathers who are missing during childbirth, and it’s someone to come and eat your biscuits for you. I don’t know if that’s my subconscious saying that my main role in childbirth is to eat biscuits. But, er . . . just the tagline is, “Who’s going to come and eat your biscuits for you?”’

At this point in the recording, there is a bleep of the PCA machine, and a rare moment of lucidity, when I suggest that this observation may have been triggered by the fact that ‘the drugs are being handed out with a trowel at the moment’. There’s more of the same. A lot more of the same, and also a few observations that suggest I am starting to assimilate what has happened to me. Only I’m not, on account of the morphine I am feeding myself at the touch of a button.

Then the morphine stops. I don’t know this at first. The machine is still bleeping cheerfully when I press my little green button, but the pain seems to be getting worse. The dosage is upped, but still the pain worsens. Finally, I am screaming and in tears and the ward sister gets really furious with the pain-management doctor, who realises that the PCA machine is malfunctioning and finally, after 24 hours of excruciating pain, the pain doctor concludes that I need something much stronger than the PCA now, and she stands around with several other doctors discussing what a good idea she’s had, and I scream, ‘Just give me the fucking stuff!’

She looks around, rather flustered at the rude intrusion, the group of doctors breaks up, and someone is sent for the drugs trolley. I am given a small capsule of something very, very strong and I gradually drift away from the pain which, although still there, feels remote and imprecise.

From now on, my stay at the Royal London is punctuated at regular intervals by large doses of Oramorph, a kind of liquid morphine, which becomes virtually my only ‘food’, other than the odd piece of melon and occasional coffee which I insist on sending visitors out on long and confusing missions to procure on the rare occasions of coherence.

Most of my time is spent passing through consciousness, sometimes contented, in a warm blanket of painlessness, at other times filled with sadness and overcome with tears, but weeping for the pain that those around me must be feeling. The visits remain upbeat, but it is not hard to see the concern etched on people’s faces in the pauses in our incoherent conversations.

I sleep a lot, and the edges between my dreams and reality become almost seamless. I am aware of my brother and stepdad visiting me, but I am unable to acknowledge their presence, especially as they are sitting at a grand piano, which they have somehow smuggled onto the ward. The ward that now resembles the library of a stately home. Every now and then there is a long beep and one of the staff will call out, ‘Breathe, Tim, breathe,’ as I am on so much medication by now that my respiratory rate keeps slowing down so far that the monitor starts to bleep in alarm.

I ‘wake up’ to find that reality is actually a dream that I remembered from several weeks before the accident, and that I am living in a shipping container in a shanty town in a third world country. I can’t speak the language, and I am an amputee from the waist down. Cute. It takes about five minutes to rebuild the Royal London Hospital around me again, and get back to what is still a pretty depressing reality. The ward changes. From the grand library, it becomes bright and airy, half glass and empty, except for my bed and the nursing staff. Next, I am in a huge queue of hospital beds stretching out for miles.

In time, I become a little more coherent. The bed I am in is designed to prevent pressure sores, and I am no longer being turned. I can raise the head of the bed so that I am able to ‘sit’ up, supported by an air mattress that thrums away, day and night, creating a warm and fuzzy background noise that suits my warm and fuzzy medication.

Friends come in a regular stream, most talking about stem-cell research, as this seems to be the biggest internet hit when trying to find out anything about spinal-cord injury. There is lots of positive talk of breakthroughs in the field, and exciting possibilities. I listen with detached interest, and make encouraging noises. However, there is also one friend who comes in and sees me who has an interesting ‘think outside of the box’ take on the whole thing. In a lull in our mundane conversation, he looks up and says, ‘You know, with nanotechnologies developing so fast, it will only be a matter of time before you’ll be able to get some kind of exoskeleton that you can strap onto your legs, and use to walk run leap huge buildings.’

I have a plaster cast taken in order to make a full torso brace, which will support my back when I sit up properly, and plans are afoot either to move me to a spinal unit, or to carry out my rehabilitation within the Royal London, where I would be the only spinal patient going through rehab. There is discussion about several spinal units, and I hear the name Stoke Mandeville mentioned, which triggers a strange sense of familiarity. I reach for a childhood memory and realise that this is probably the first time I have heard those two words unaccompanied by the name Jimmy Savile. It sounds strange, like hearing a long conversation exclusively about Ernie Wise.

One of the professor’s team, the senior house officer Scott (again), who turns out to be a Tottenham Hotspur fan, finds out about my lifelong Arsenal obsession and, as well as distracting me with football banter, he takes the time to show me my X-rays, and explain about the spinal cord and the damage I have sustained.

‘The nerves leave the spinal cord in bundles through each vertebra. They then travel down to the areas that they serve. In your case, the nerves are damaged where the last thoracic and the first lumbar vertebrae meet.’

He shows me a chart, a sensory ‘map’ of the nervous system. It is an image of a man with horizontal lines marked across his entire body, each section marked with a letter and number denoting the vertebra that relates to the nerves.

‘The thing is,’ he continues, ‘after a trauma like yours, the nervous system can go into what’s called spinal shock, which is a temporary defensive reaction, and means that it isn’t possible to do a definitive assessment of your neurological condition until things have settled down.’

‘How long?’ I ask.

‘About five weeks in some cases.’ He pauses. ‘Although, to be honest, looking at the damage to your spinal cord, it looks like it’s about ninety-five per cent severed. The likelihood of you regaining any sensation in extremely remote.’

By taking the time and being fully open, he begins my understanding of the full implications of my injury. For the first time, I feel like I am being included in my treatment, and I realise how important this is.

As time goes on I become more aware of some of the other patients around me on the neurological ward. There’s a patient opposite me called Barry, who I can just about see from my prone position, and who turns out to be another Tottenham fan. Together we demonstrate the importance of football as a male language in order to reach out, without looking like you are actually reaching out, if you see what I mean. Anyway, while he’s helping me, picking up call buttons and whatever else that I drop in the night, unbeknown to me, Penny has been helping him by doing a bit of shopping, and I make him a gift of one of the several pairs of earplugs I have obtained (never go to hospital without them is my advice, especially if you are in the bed next to me, by all accounts). I find out later, when I receive a touching letter and a signed picture of the whole Arsenal team, that Barry is actually a golfing partner of George Graham, the former manager of both Tottenham and Arsenal.

To my right is a man of about twenty-something who has suffered some sort of neurological trauma that has affected his long-term memory, but seems otherwise fit and well. He is a student, and often receives visits from friends and classmates. The trouble is, he has no idea who they are. Every morning when he wakes up I hear him have the same conversation with the staff nurse.

‘Good morning, can you please tell me why I am in hospital?’

‘Yes,’ comes the reply. ‘You have a neurological problem which is affecting your memory.’

‘I see, I see. And, who am I, please?’

It is difficult to listen to, especially when his friends visit, and they lose patience after he asks them the same question about how he knows them for the nth time, and their answers become less gentle and more mocking. I can imagine that it will not be long before he stops receiving visits, and I think of his life lost somewhere, perhaps never to be continued. I begin to understand just how important it is that my physical impairment hasn’t compromised who I am, and I get a bit of an insight into just what must have gone through Penny’s mind between seeing me fall and hearing me talk.

More days and nights pass, and I haven’t had a bowel movement since the accident, although the urine bag attached to the indwelling catheter that is attached to me is being emptied frequently. So frequently that one of the staff nurses asks if I can go easy on the fluids, following a day when I pass over eight litres of urine. Morphine makes you thirsty. And it constipates.

Another week begins with the news that a bed has been found for me at Stoke Mandeville, and I am to be moved on Thursday (thirteen days after the accident). Then I am told that there isn’t a bed for me, but that they have accepted me in principle, and that they have a ‘bed meeting’ every Friday. Sounds cosy until I realise that this simply means a meeting where they discuss how many beds are available, rather than some kind of pyjama party.

Between her daily visits, Penny spends her time talking to our accountant, the Health and Safety Executive, and making the last few difficult telephone calls to friends who haven’t yet heard. Our friends and family rally round, and ensure that we don’t have any immediate financial worries, and I feel as if I have a large net protecting me from day-to-day worries and allowing me to concentrate on what is happening to me. Penny also spends time trying to find information on the internet, as do all of our friends, and when she comes to see me she nods and listens intently as I tell her the latest bit of information I have gleaned, not revealing that she knows it already.

Friday comes around, and the word is that I have a bed, and I will be moved up to Stoke Mandeville on Monday. In the meantime I am moved into a side room, which feels like such luxury, despite the non-functioning television and the peeling paint. In the morning the ward sister, having asked Penny if I usually wear a beard, comes in and gives me a shave, a gesture of great kindness that makes me feel a little stronger about facing the day, as the morning is the hardest part of the day, waking up and finding that it is all still real. I still haven’t seen myself in a mirror, but Penny tells me that one of the things that she finds really bewildering is that I still look so healthy.

In the afternoon the physiotherapists at the Royal London put me in the new, made-to-measure fibreglass waistcoat, and I manage to sit up on the end of the bed. The sense of achievement leaves me weeping. I feel like Douglas Bader in Reach for the Sky. By this time I am being given morphine twice a day, and on demand every two hours if required, so I actually think that I am Douglas Bader in Reach for the Sky.

The weekend comes and goes, punctuated by visits of family and friends, all impressed at my bravery and sanguine cheerfulness. It is easy to play this role, all the time insulated by the detachment offered by the medication. The only thing that punctures my protective layer is when I insist Penny brings in the photographs from our recent trip to Australia. We got back at the weekend, and I had the accident on the following Friday, not even long enough to get the photos printed.

The opening few are images of me and a friend on the beach in Melbourne, charging around kicking a football (Aussie rules). We attempted to stage epic catches and scenes of sporting brilliance, clowning around on the beach, jumping and running and eventually hurling ourselves into the ocean. The impact of these images is unavoidable, and I quickly decide to defer the picture show until some other time. This decision is enough for the heavy, red-velvet pharmaceutical curtain to close again.

As the amount of morphine administered is increased, so are the doses of laxative, but without effect. On the Sunday, I notice a hard lump in my abdomen, and I am sent for an X-ray, dropped by the porters onto a hard stretcher with profuse apologies for the intense pain caused, wheeled over painful lumps and bumps down a corridor that looks so old that I am expecting any minute to pass a top-hatted Dickensian character called Mr Bumblesnatch or some such. The X-ray reveals the lump to be ‘nothing’. The cause is constipation.

Monday arrives and no sign of my transfer. The ward sister phones the bed manager and she is told that I will be moved on Monday or Tuesday.

My parents come and visit, and it is as if I am full to overflowing with the pain and sadness of my situation, and at last I cry properly, uncontrollably. I cry about my condition and because I am terrified, but I also cry at the pain that my situation is causing to those closest to me, and it is this that I find most difficult to bear.

The lump in my abdomen is still there, and is joined by another. On Monday night, things take a turn for the worse. Chronic or compacted constipation can cause the sufferer to dry retch as the system backs right up, and the body tries anything to rid itself of waste products. It also causes a pain that the morphine cannot touch.

I get no sleep whatsoever that night, between the dry retching and two further trips to X-ray to confirm that it is ‘just constipation’. By Monday morning I am in a very bad way. The ward sister arrives on the early shift, and takes over, performing what is delightfully referred to as a ‘manual evacuation’ every hour for three hours until the pain subsides. Just as she gets me comfortable, she is shocked to find an ambulance crew on the ward to pick me up for the journey to Stoke Mandeville. She and Penny have fifteen minutes to get me dressed and pack up my various goods and chattels (which one accumulates surprisingly fast in hospital), before I am transferred onto a stretcher with a discreet handful of pills for the journey, and we head off through the hospital and across the car park, conducting teary farewells with the wonderful ward sister and promising triumphant return visits after rehabilitation.

So off we go to Stoke Mandeville hospital or, more accurately, the National Spinal Injuries Centre. I am still whacked out on morphine for the journey up, and the ambulance ride is pretty uneventful. Penny travels with me, and we both feel that the move to a spinal unit is a positive step, although the prospect of being 40 miles from home in Hackney is difficult to face, especially as we aren’t sure how much longer Pen will be able cope with all the travelling as her bump grows ever larger.

When we arrive at the spinal unit, my only view is the ceiling, except for a brief glimpse of someone in a wheelchair going past at high speed, which triggers a vague sense of there being a future, a thought that causes a lump in my throat. It is the closest thing to relief that I have felt so far. We emerge from the lift and the spinal unit has an atmosphere of peace and calm control compared to the chaos of the Royal London. This is not the only contrast, as I am given somewhat different treatment.

I am put into a normal bed, instead of the airbed that I have been in since the operation. I am not allowed to sit up, as they treat all patients as spinally unstable on arrival until they have verified the fixation for themselves, and often they decide to redo the surgery. I meet my consultant, Dr J, for the first time. He strides into the room, making strong eye contact as he shakes my hand, and introduces himself in a soft, calm voice. I feel an incredible sense of strength and reassurance from such a small gesture. He is the first senior doctor I have seen who has made direct physical contact in this way and, possibly due to his many years of experience in dealing with spinal patients, he makes me feel like I am at the centre of things, and important in the decision process. It’s difficult to explain, but I’m sure it’s his habit of speaking to the patient first, before talking to all the other relatives, friends or staff who may be in the room. He tells me that I am ‘on Stoke Mandeville time’ now, and that I have to start thinking of things in terms of weeks rather than days, a concept that I accept with a grin, but which becomes a painful frustration in time.

My most immediate problems are identified, namely the compacted constipation and my drug habit, and I am taken off the morphine. Not weaned off, taken off. No more.

2

AND SO I begin the worst two days of my life. Cold sweats, pain in my back and insomnia are all indications of how insulated I had been from the physical reality of the injury I have sustained. I have attacks of nausea punctuated with more bouts of dry heaving as my body tries to clear itself. The retching is loud and very painful, and produces nothing but a small amount of bile and extremely sore stomach muscles and throat. Then there is the psychological impact. The fact that I have been on such large amounts of opiates since the accident means that I have also been insulated from the full psychological implications of what has happened.

On Tuesday it all caves in on me at once, and I am a real mess. I feel the worst kind of claustrophobia at being trapped inside my own body. Any attempt to move my legs, or even to move in bed leads to a lurching panic attack, as my brain reacts to the lack of response from my body. I become distraught that I can’t ‘wake up’ from what is happening. In my mind, I run a parallel life, the one where I don’t fall from the tree, and I imagine what I am doing instead of lying in a hospital bed unable to move. I try with all my will to jump from this world into that, but it doesn’t work and the panic rises again and turns into cold dread. I look at Penny holding my hand and looking so calm, as if pregnancy has made her indestructible, wrapped her in a warm, living shield and the thought of what she’s going through is enough to reduce me to a howling, sobbing mess.

I feel almost resentful that I can’t even consider giving up, as I have a wife who loves me, a family who love me, and I am three months away from being a father for the first time, something that had filled me with nervous excitement before the accident. It was a part of my justification for the whole tree-surgery thing.

Although Penny and I are both artists, this has never been a reliable source of income, and for the last three years we had run our own garden-design and construction business. Now that Pen wasn’t going to be working for a while as parenthood takes over, I thought that if I train for tree surgery, I can always get a bit of other work to help to support us. I remember seeing a tree-climbing competition at Westonbirt arboretum, and we were both thrilled and inspired by the sight. Having previously spent some fifteen or so years working as a telephone engineer and regularly climbing telegraph poles, I knew that I enjoyed working up high and, coupled with my love of trees and the outdoors, it seemed a perfect combination to make a successful arborist.

I think back to a long walk in the bush and a conversation I had with Leon, my father-in-law, when we were in Australia just a couple of weeks ago. He is a furniture maker with a passion for timber, and we talked about trees and timber and careers, and I sensed that I had found something that I loved and could even make a living at. Especially something that would be in demand if we moved to Australia, an intention that we have held for some time. But somehow something always comes up. Or falls down. But when we’re there, it’s really clear that we can do it, and I can see a life for us there.

Instead I find myself staring at nothing, completely unable to move or speak or think. While Penny has been allowed to stay over in one of the relatives’ rooms provided by the hospital for the first couple of nights, it is clear that this has just been a very temporary measure, and that it is time for her to return to London in order to keep our life ticking over, and for a change of clothes. Fortunately, I have the presence of mind on the Wednesday afternoon to ask to see someone from the psychology team, as I feel that I am sliding out of control. The day is also punctuated with a visit by the hospital chaplain.

Speaking softly, she asks me, ‘Would you like someone to come in and see you from time to time for prayer, a chat, or even just to sit with you?’

I explain that I am an atheist, trying to sound earnest myself, as if I were explaining that I was a Methodist or a Catholic.

‘That’s absolutely fine. No problem. We’re still happy to come and talk if you think it could help.’

I say that I would like that, although I’m not sure why, and I never hear from her again.

This is now the second time that I have been approached by people who would claim to be doing His work on earth, and after she leaves I have a little rummage through some of the more obscure boxes in the back of my mind. Conversations with God? Conversations about God? An internal dialogue, perhaps. When one is lying in a hospital bed as the result of a near-fatal accident, it is probably inevitable that, as an atheist, I find myself wondering if my rather vocal anti-God (well, more anti-organised religion, and if I’m honest, the organised is a relatively recent caveat) opinions have led me to this situation. I’d certainly have to admire the Big Fellow’s sense of humour.

On Thursday I wake up and stare at the wall, unable to acknowledge anyone who comes in to see me. I feel as if I can avoid all of the hurt and panic as long as I don’t move or speak or think. A member of the catering staff comes in to take my order for lunch, although I haven’t eaten anything for two days. I don’t even acknowledge her presence. She leaves, and soon after I am joined by a student nurse who is so concerned by my ‘closed down’ behaviour that she returns with a staff nurse.

She asks me directly, ‘Tim, are you all right?’ and I realise that she is not going to let me get away with the silent treatment.

I manage to utter, ‘Help me.’

But the nursing staff on the ward have already recognised that this is an urgent situation, and instead of waiting for my scheduled appointment on Monday, a psychologist is summoned from the first European conference on the Psychology of Spinal Cord Injury, which happens to be taking place at Stoke Mandeville the week of my admission.

Dianne, the psychologist, arrives to see me, and the first thing that she has to deal with is my utter panic, which is causing me to hyperventilate as I attempt to crawl out of the hospital bed. She explains how important it is for me to consciously take control of my breathing in order to combat the fight or flight response that a panic attack induces, as by slowing the breathing down the body sends a message back to the brain to say that there is no imminent danger, and I can begin to wrest control back.

Once I have stopped huffing and puffing like a demented wolf, I pour forth lists. A list of all the things that I will never be able to do again, a list of all the things I will never be able to do for the first time, a list of all the things I will now be unable to do with my child, a list of all the emotional aspects which I can’t come to terms with, and she says, ‘Don’t. It’s too big for you to deal with now, while you’re still unwell, and so recently injured. There is a “cod” psychology phrase that actually holds some truth in situations like yours. It’s “fake it until you can make it”.’

This totally wrong-foots me, as the message seems to be denial is good. But it helps, and it is true. Lying on your back staring at the ceiling of a hospital room for two weeks is far too much of the wrong kind of time to come to terms with anything, let alone a huge life-changing event. So I don’t. Or rather I try not to as best as I can. In a way, she tells me it’s OK not to think. I have to fill my head with white noise. Listen to music, read a book, or watch TV.

I am joined in the afternoon by Penny, and I lose it a bit again, although now I don’t feel quite so out of control, as I have accepted that I can’t begin to accept anything yet. While I have been busy falling apart, Penny has been busy ploughing through forms for various benefits with the help of Graham, who has worked in local government for many years, but is still shocked by the complexity of the bureaucracy involved.

My father arrives for a visit and stays the whole afternoon, obviously impressed with the spinal unit, which is probably due in no small way to the comparison with the Royal London. The next visitor is a timely one. A wonderfully mumsy Australian woman called Marion introduces herself as my discharge co-ordinator and makes Penny promise that she won’t fill out any more forms, because that’s what the discharge co-ordinator does. She strikes the perfect tone, and reassures us that we are in the best spinal unit ‘in the world’, which is why she came to work here, and that there is a department, her department, which is there to negotiate all the paperwork and pitfalls to do with getting out of here and going home. Marion also imparts a somewhat peculiar gem of wisdom. She tells us that having a spinal-cord injury doesn’t change who you are fundamentally. ‘For example, if you were an arsehole before your accident,’ she says in a conspiratorial whisper, ‘you are likely to be an arsehole after.’

The whisper tells me that:

  1. somewhere on the ward there is an arsehole who has just had a spinal-cord injury, and
  2. it isn’t me.

Soon after, Jackie comes to visit us. Jackie works for the Spinal Injuries Association, the SIA. I immediately decide to cancel my membership of the ISA (International Society of Arboriculturalists) and join the SIA while quietly wondering what the AIS might be, as I am bound to end up a member eventually.

Jackie is the first person in a wheelchair that I have spoken to since my accident. She looks at me and smiles and, without saying anything, I know that she has been through something similar to what I am going through. That feeling is indescribable. Well, maybe not, maybe it’s called empathy, but it is a huge lift for me.

She tells me about her experience. ‘I had my injury when I seventeen, in a fall from a climbing wall. As this was 25 years ago, there were very few operations carried out then, and I was put on twelve weeks of bed rest, which was the way that spinal injuries were treated.’

I think about my struggle with being flat on my back for two weeks.

Jackie then tells us, ‘Since then, I learned how to ride a horse again, learned to drive, got married, had two children, raised them, got divorced, and I have recently discovered skiing.’ In other words, she has led a full and active, ‘normal’ life.

After she leaves, my father says, ‘Well, what a wonderful lady. So positive and lively.’ I realise that we all need a positive role model at this stage. Someone to represent the future. In suffering a spinal-cord injury and becoming paralysed, I have lost many things. Not only have I lost the use of my legs, I have become impotent, and lost control of my bladder and bowels. But I have also lost all of the versions of my future that I had imagined for myself. None of them involved me in a wheelchair, and the loss of this future, as well as the way that I have been whisked away from the past (I left the house in the morning like any other day, and weeks later I am on my back in hospital), makes the meeting with Jackie hugely important. Seeing someone who has got on with her life after just such an injury helps me to start the construction of an image of life beyond the hospital, something I have not even begun to do up to this point.

So I start my rehabilitation. On the Friday I meet the head of the psychology department, Dr K, and he casually swats away all of my concerns with a bit of ‘cognitive thinking’ delivered in a warm Irish brogue. Very encouraging stuff at first. After convincing me that a wheelchair is merely a functional device to