James Moore: Life after near-death
Four months on from a horrific cycling accident, James Moore recounts his remarkable recovery – and explains why he owes his life to the kindness of strangers
Tuesday 07 June 2011
With the NHS facing severe criticism, and in organisational turmoil thanks to the Coalition's faltering reform plans, perhaps it is worth remembering just how impressive it can still be. I should know. Its performance after the events of 17 February, which are seared into my memory, is nothing short of stunning.
Let me explain. Anyone who cycles in London knows it is fast and fun and dangerous, no matter how many cycle paths BoJo puts up. If some of us are honest, that is part of what makes it fun. Probably everyone who does it can tell a horror story of their own near miss. But despite all the gruesome statistics about accidents, you never think that one of those near misses will ever turn into a hit. That's certainly what I thought. Until it did happen to me, when I came to grief under the wheels of an oil tanker.
In London one becomes accustomed to hearing stories of people suffering horrible misfortunes. These stories are made worse when passers-by shrug their shoulders and walk on by, often because they fear for the consequences of "getting involved". I owe my life to two people who did get involved – the driver behind, who stopped his car, got under the truck and kept me going until the fire brigade and medical staff were able to release me and get me into the ambulance. And the person who jumped out in front of the lorry to stop it before critically ill turned into something worse. I've subsequently met the driver and been able to say thank you. I wish I could shake the hand of my other saviour, but to this day we have no idea who it was.
After the air ambulance had picked me up and deposited me into A&E, the initial prognosis was not good. One of the reasons the police tore through east London, sirens wailing, after my wife had suffered the horror of the knock on the door from grim-faced officers, was that they wanted to get her and my three-year-old son to the hospital so they could see me one last time before the end.
I'd managed to break my pelvis, left leg, left shoulder, left elbow, right collar bone, several ribs, a toe, not to mention crushed lungs and a plethora of internal bleeds, cuts, scratches and scrapes. Today I wear my scars as badges of honour. Subsequently it emerged that I had also managed to damage the nerves leading down to my feet. Even today the neuropathic pain that causes can leave me in a ball of agony. It might be easier to list the parts of me that weren't affected – including, thanks to an incredible piece of luck, my head (I was not wearing a helmet).
A list like that is the stuff of the TV shows Casualty or ER, when the producers want to spend a bit more on the production budget at the end of season to do something really dramatic. On screen, the patient usually doesn't make it, so the regular cast can practice their acting skills. Thanks in no small part to the Herculean efforts of the surgeons, doctors and nurses in the Royal London Hospital's intensive care unit, I did, although it still leaves an icy feeling in the pit of my stomach when I look at that list of injuries.
Another stinger was missing the birth of my daughter, and the frighteningly vivid drug-induced hallucinations after coming out of a coma that led me to believe my wife had suffered a miscarriage.
Even when the worst was over – complicated by two serious infections – it was expected that I would spend at least a year in hospital. As it turned out, I would be out within three months.
Proving doctors' pessimistic prognoses wrong can be a powerful motivator by itself. But I owe just as much to one nurse – and a strong desire to get out of hospital as rapidly as possible, something that increased by orders of magnitude as I was moved out of her care.
She was originally from Zimbabwe, and seemed like something of a throwback to the classic image of the hard-nosed matron of the 1950s – brisk, no-nonsense and all dressed up in a severe dark blue outfit. The sort of person you'd like to have on hand to get on the phone when your insurance company is giving you grief. However, she also had a softer side.
I was not long out of intensive care when the nurse insisted I get out of bed. In my early days on the ward this was anything but a simple task. It required at least two nurses (and sometimes three) to first get a sling around me and then attach it to a hydraulic winch, which would lift me up and then down into a special orthopedic chair. On that first occasion I was in the chair for 15 minutes before I was desperate to get out and back into bed. The sensation of being upright, even in a chair, is not a pleasant one when you have been bed-ridden for over a month, two weeks of which were in an induced coma. First there is the nausea, which threatens to overwhelm. But worse, it is rapidly followed by agonising aches and pains in various parts of the body that have become completely unused to being in a sitting position.
It wasn't long before I was begging to be put back into bed. She would not hear of it. Sitting out would do me good, in fact it was essential if I wanted to recover. She did eventually relent, at least on the first occasion, but not before warning me that I would be out again the next day, like it or not. As time went by it got to the stage where we would haggle over how long I would stay out, as if we were arguing over the price of a carpet in a Moroccan souk. She would set a ridiculously high target (four, five hours) while I would try to batter her down. Usually we'd come up with some sort of compromise. Only later would she tell me that she was winding me up.
But her bullying – perhaps it would better be described as tough love – worked wonders. After a few days I was asking her to get me out rather than the other way around. She managed to instill within me a fierce determination to get better, one that would serve me well in the weeks to come as the physiotherapists got to work.
In fact, after I was moved to a different ward (in a move typical of the NHS's darker side – having gradually settled in and started to make progress, out of the blue I was told I was moving with barely an hour's notice and only a cursory explanation as to the reason), she stopped by to see me, while dropping off some of my notes.
The job could easily have been assigned to a more junior colleague – but she told me she wanted to see how I was doing. The new ward was not as good at getting me moving as the first and I had in fact been lounging around in bed for a couple of days. That was in fact partly because of the difficulty in persuading staff to undertake the complicated task of moving an all-but-immobile patient from bed to chair. But I hadn't exactly pushed the issue. "Are they getting you out every day?" she inquired, and looked furious when I explained that they were not. And why. I resolved to push the issue the next day. Oddly, I felt I owed it to her, perhaps because she had put up with my complaining with good humour. Also because she had dealt with some of the more unpleasant consequences that come with looking after an immobile patient – consequences that can be humiliating for the patient – with a calm good nature and businesslike efficiency. Even when, as a result of one of those infections, I threw up everywhere: "Don't apologise," she chided as she went about the task of cleaning me up.
In fact the only time she ever got really cross with me was when, for some reason, I admitted to voting Liberal Democrat. "How could you vote for Nick Clegg? It's all his fault!" she exclaimed, before she proceeded to give me a lengthy lecture on the finer points of just why the Coalition's health reforms will send the NHS to hell in a handcart.
Those reforms seem to have little to do with improving the patient's lot. As time went by and I moved from critically ill to rehab patient, the weaknesses of the NHS became more obvious (fuelling the motivation to prove the doctors' predictions of a year in hospital wrong).
The transfer from the London to Whipps Cross, for a start. My arrival was unexpected (apparently no one had called ahead) and I spent nearly an hour on an ambulance trolley awaiting a bed; a bed on which I was soon writhing in agony – while my drugs charts had arrived, I wasn't allowed to take anything until they were okayed by a doctor from Whipps. Who didn't appear until the early hours of the morning. This was like torture, thanks to the severe neuropathic pain in my feet (the sensation is like walking over red hot coals) caused by those damaged nerves.
The notes on my various injuries also took days to arrive, causing problems for my beloved physios (I never met a bad one and they crucially represented progress).
Then there were the occasional humilations connected with being immobile, or partially immobile. There are many truly incredible people among the workforce at both the London and Whipps. I really don't know how they do what they do. But there are also those who are less than sympathetic. You might, as one nurse told me, leave much of your dignity at the door. But that's no reason to compound the issue. And regrettably, some do.
Sadly, a lot of one's time in hospital is spent fighting small, silly battles, against an irksome and unnecessary bureaucracy. So bad was it in my early days at the new hospital, that I felt I was in the middle of a constant struggle with no one on my side.
Ultimately, I won through. Battles against inflexible hospital bureaucracies are ultimately usually winnable for a 39-year-old, stroppy journalist, especially when you have as a daily visitor a mother who used to be a primary school headmistress in a rough area. (That's a powerful ally.)
But if you're elderly and vulnerable and on your own, it's all too easy to see how things can quickly go awry. All the same, while the NHS needs to look very carefully at how it treats people after they have come through the eye of the needle, the fact that it got me there in the first place is, for me, nothing short of a miracle.
James Moore is deputy business editor of 'The Independent'. His blog charting his recovery starts soon on www.independent.co.uk/blogs
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