5th March, 2018.
I’m going too fast. The snow, in the shade of the mountain for the last 40 minutes, has hardened surprisingly rapidly. The shape of the slope and the mini-topography of surface lumps and holes are no longer clear, as they had been in the sun. Below I see my objective – the snow-bridge beside the lower end of the ski-lift – which I am to cross at speed to avoid an annoying ‘push’ up the hill beyond, allowing a nice effortless ski down to the village. No-one likes to push.
I’m going much too fast. I miss my turn. I pass the piste-markers and prepare myself for a rough turn in the uneven snow.
‘Can you move your legs?’ asks someone I don’t know. There are three strange faces upside-down above mine. ‘Yes’ I say, adding ‘I think I can ski back down on my own’. I’m pretty sure this exchange is in German, but who knows.
I seem to be strapped on to a toboggan.
I am in a helicopter.
Then on my back looking at the square fluorescent lights in a corridor ceiling, people around me shouting in Swiss German. Someone tells me what room we’re entering. It makes no sense.
Someone says ‘I’m going to stick my finger in your anus. Please squeeze it hard as soon as you feel it.’ I do so. There is an outbreak of activity.
I wake up in the intensive care unit of Luzerne Kantonsspital, the equivalent of a district general hospital. I feel no pain. I cannot move; I don’t want to, it seems like a bad idea. Around me, many display screens and much beeping. Everyone is beautiful.
Perhaps blame the opioids, but the above is all I remember of the events immediately prior to transferring to the general ward. Dear people – my daughters, friends – came to visit, I’m sure. Nurses kept me comfortable. Doctors explained what, by my own stupidity, they had been required to do – so, so skilfully – to my body. I can’t remember when these facts were imparted or when I first registered them properly but here are the main points:
- I tore my aortic arch. This is the main blood vessel crossing above the heart and serves to distribute blood from the heart to the head and arms before turning down to feed the rest of the body.
- As a consequence my spinal cord was starved of blood and partly died.
- As a result I have no control of my muscles from the waist down. I still have some sensation, however.
- They repaired my aorta with a graft in the form of a PTFE stent.
- In doing so they blocked the subclavian artery on the left. This required some re-plumbing, so now my left arm gets its blood from the carotid artery on that side.
- I broke 6 ribs on the left, one of which pierced my lung.
- Three of these 6 were repaired with titanium scaffold and screws.
You might expect that there was some big, shattering moment when I suddenly realised that I could not walk. I don’t remember one – perhaps the opioids again. There have however been many small, self-pitying moments when this grim fact has made its weight felt.
You might also expect the immobility and consequent lack of autonomy to be the hardest part of spinal cord injury. It’s not quite that simple. The incontinence is nearly as bad; sometimes – in pure loss of dignity, miserable powerlessness and the involuntary involvement of others in one’s most personal mess – it even seems worse. Maybe that’s just me.
Luzerne Kantonsspital is a wonderful place, staffed by angels. Kind and efficient Swiss angels complemented by many immigrants – German, Dutch, East Europeans –all splendid team-workers. The nurses all seem to be below 20. All are slim and sylphid and have beautiful, caring eyes in various shades of blue and green. They wear all-white uniforms and training shoes. I imagine them to be specially raised in gentle herds on pure green alpine pastures, feeding on mountain ambrosia and cool, crystalline water.
For me, on the other hand, feeding is a problem. Something is clogging up my bowels and killing all appetite. They bring me tray after tray of beautifully cooked and artfully presented (nasturtium flowers!) meals, and all I feel is revulsion. I force myself to eat on the grounds that I need energy. I leave the nasturtium flowers though; I’ve never been sure about those.
When I am taken up from Intensive care I am at first wheeled into a room for two with an existing occupant, who looks up, baleful and obese. He looks like a snorer. A young nurse – ‘Jimmy’ – quickly decides that I should have a room alone to allow space for the physiotherapy. Later the senior nurse apologises for my isolation. I tell her not to worry about it.
Remembering the names of those who are helping me is very difficult. There are so many of them and they are very formal, the Swiss. I’m Herr Carter whatever I say, and it’s Professor or Doctor this and Frau that. I can barely read the name tags and of course forget immediately when introductions are made. Jimmy is not called Jimmy, I name her this after the support tool used in ICU for the sitting exercises they quickly get me doing. I think the Jimmy tool is in the form of a huge teddy-bear but that might be one of the opioid-induced memories. Anyway, they did not have a Jimmy on the ward; “I’ll be your Jimmy” said this nurse, smiling. When, a week later, she goes on holiday she leaves me a long, encouraging letter explaining how she too had, 8 years ago, been paraplegic. ‘Never give up’ she says.
Dr O is my saviour, quite literally. It was he who fixed the broken aorta in minutes after the realisation that the blood was pumping out, not around the usual cardio-vascular plumbing. He accessed – via both femoral arteries – the aortal arch and repaired it with a stent – a covered mesh framework somehow pushed up the blood vessels into place and expanded in situ. I don’t want to know how close to death I came.
He shows me the MRI scan with a grey mess where the lower spinal cord should be. Unbidden, he advances the view that walking again is highly unlikely. I tell him I’ll prove him wrong; he says he hopes so.
The chief thoracic surgeon in Luzerne is a bull-like older man we’ll call Dr S. He is a no-nonsense old school type surgeon of extremely high repute, well-liked by the junior staff. It is he who conducts the repairs to my ribs whilst I was still in intensive care following the aorta graft. He subsequently expresses an appreciation of my musculature and strength in general, leaving me unable ever to complain of pain for fear of disappointing him.
They took me for an x-ray which I thought was something to do with the increased pain in my rib cage following an unsuccessful (had it not been so painful it would’ve been comical) transfer back from the chair to the bed. Unknown to me, this x-ray is to ascertain whether Dr S would be ready to recommend removal of my drainage catheters.
So I am somewhat surprised later that day to be woken from a nap by Dr S bursting into the room, closely followed by two worried-looking nurses. He tells me the good news: he thinks that the drainage catheters can be removed. That does sound like good news, I agree. One of the nurses seems to have with her a sort of field surgery kit of the kind I imagine was put to good use in the battlefields of Flanders. She unrolls it and starts preparing iodine dabs. Like many of the nurses here she has the innocent look of the truly good. A gentle practitioner.
Dr S Is a very direct man and wastes no time in lifting my blanket and day-shirt to probe around the areas where the catheters plunge into my side, with his bricklayer fingers. ‘Just checking his conclusions’ I think, reassuring myself, when suddenly with a ripping sound and a small grunt of satisfaction, he removes one of the adhesive gauzes surrounding the entry of a catheter tube. The other nurse, who looks like Bambi’s less self-assured cousin, gazes on in horrified fascination.
‘Surely it’s below his pay grade..’ I am thinking as Dr S removes another fixing, and
‘shouldn’t this sort of thing be done in a more sterile environment..?’ As he gives some helpful professional pointers to the two assistants.
With a few deft movements, like a gardener removing nettles from a flower-bed, all three catheters are disposed of in a slightly gory waste-bag. Both nurses look shocked at the final brisk gesture, which I learn later is to seal the holes in my side with the tails of suture left there for the purpose when the drains were installed.
My stunned speechlessness only confirms my strength to Dr S who is muttering ‘starker Mann’ as he leaves the room. But he is the starker Mann, completing a difficult job with a minimum of fuss and suffering, demonstrating how it was done to two impressionable colleagues whose attentions, superficially preferable, would doubtless have been excruciating in their gentle fear of hurting me.
One day Dr O comes up to my bed, accompanied as usual by a sizeable entourage, and tells me that there was more repairing: the subclavian artery feeding my left arm connects to the aortal arch so close to the repair that he had to block it. Still operating under high pressure he therefore reconnected the subclavian artery to the carotid. His infelicitous words: ‘your arm is stealing blood from your head’. He tells me to monitor my arm for numbness or tingling. I want to ask him if I should also monitor my brain.
Having said that there was no great shattering moment of realisation that I was no longer in charge of half of my body, I do remember this moment. Still now I don’t like the idea, it makes me anxious and mistrustful of my own heart.