The taming of the screw (and other drama)

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‘The rod would strengthen my leg while the bone healed. My leg was now wrapped in a white plaster cast that went all the way around. I looked at it, and tentatively wriggled my toes. They worked. I settled in to my recovery, which, obviously, I would ace’

ADELIA HALLETT”S STORY ABOUT LIFE IN THE PAIN LANE WITH A SMASHED LEG FROM A HORSE-RIDING ACCIDENT (SEE PART 1 , PART 2  AND PART 3).

I was right, I did vomit. Coming out of anaesthetic is the strangest feeling; there is no sense of time having passed. It’s as if a split second after you were being put under you’re awake, but in a different place, and feeling dizzy and sick. Voices are calling your name, and for a bit you don’t know what’s happened, and then it comes back, and you realise that you’ve had the operation and you’re now in the recovery department.

Which, to me, was important, because that’s how I thought of it. There was the accident, the rescue, the repair job, and the recovery. I had got through phases one, two and three, and now I was on the home straight. My leg had been fixed. The surgeons had opened it up and shoved a titanium rod down the inside of my bone. Titanium. I had a mental picture of it blue-black and shiny. The rod would strengthen my leg while the bone healed. My leg was now wrapped in a white plaster cast that went all the way around. I looked at it, and tentatively wriggled my toes. They worked. I settled in to my recovery, which, obviously, I would ace.

There was just one cloud on the horizon. Before I went into the theatre, I had asked someone – an orthopaedic surgeon – about recovery time. I put the six-week, three-month formula I’d heard in accident and emergency to him. He laughed, and told me it would be three months to four months before I was walking, and much longer until I was back to normal. I wanted to think he was wrong, but I had to allow for the possibility that he might be right. Nevertheless, I thought I could still make the annual Maungaturoto Primary School trek in February. Okay, I mightn’t be able to walk properly, but that didn’t mean I couldn’t ride. Life was still good.

Back up the ward, I enjoyed my post-operative status. I was allowed to eat, and enthusiastically filled in the menu card for the next day’s meals. I chatted with my neighbours, comparing details of what had been done to me with what had been done to them, and optimistically told Sandy that I was still hoping to be allowed home on Wednesday (it was Tuesday).  I even got a bit of sleep that night, although did spend quite of lot of it listening to long documentaries on the All Night Programme.

Hopes of going home the next day faded with the morning. I was helpless. Before my operation, all my personal needs had been met in my bed. Post-operatively, I was to get up to go to the toilet and to wash. I was happy about this, but fell at the first hurdle, so to speak, which was getting out of bed. Whole people lift their legs off the bed, swing them to the side and stand up. I realised that the standing bit might be hard, but surely I could get myself out of bed. It turned out I couldn’t. The co-ordination required, not to mention the flexing of leg muscles, wasn’t there. Getting out involved having a nurse lifting my legs off the bed and lowering them to the floor, after she’d helped me to roll on to my side and shuffle to the edge of the bed. Once I was upright and leaning against her and the bed, she rolled a walking frame into my grasp.

walking frameOne of my roommates had been using one of these, and I had watched the technique. Push it forward and walk behind it. Not unlike pushing a child in a pram. The catch was that while I could do the pushing bit, my legs were having trouble with moving in a walking-like fashion. Balance was also a problem. I just couldn’t find it, and realised that without the nurse and the walking frame, I would be in a heap on the floor.

The bathroom was about 20 metres from my bed, across the hall and down a bit. The nurse helped me to the toilet, which had a metal frame over it, and a hand-basin beside it, and left me with a clean towel, gown and underwear. Which was all very well, until I realised that I couldn’t put my knickers on by myself. Think about it. Sit in a chair, and try to do it yourself. Unless you have super-long arms, or are unnaturally flexible, you have to bend your legs in order to able to bring your foot and your underwear into the same space. Add to that the fact that with your lower leg fat with plaster, you have to be able to stretch the leg hole in your undies at the same time that you put your foot through, and you’ve got a problem. I rang the bell and the nurse came and helped me.

Later, a nurse aide took me for my first shower. This time, I managed the walking frameshower a bit better, and was really looking forward to getting properly clean. The shower was a sitting-down affair, with a metal frame similar to the one over the toilet, and a removable nozzle. There was no question, as far as the nurse aide was concerned, of me being able to do it myself yet. She sat me in the chair and helped me to undress. My plaster cast wasn’t allowed to get wet, so she covered it in a huge plastic bag that was taped tightly at the top, turned the water on, and handed me the nozzle. By now I had been “up” for about 10 minutes and was feeling awful. I vomited, and it ran over my body and down the drain.

My companion was gentle and patient. She made clucking sounds and took over washing me, a process which I could have found invasive but instead found empowering. That’s a word I usually hate, but I can’t think of any other. Telling me that my dignity was the most important thing, this lovely, lowly-paid immigrant from Fiji said she had started training as a nurse, but preferred hands-on caring for people to the technical stuff. So, for not much more than the minimum wage, she and her husband work in our region’s largest hospital, helping people like me to get back to normal. As she brushed and plaited my wet hair, I couldn’t help but feel ashamed of the shabby way in which our society treats the people who care for us, while exhalting and rewarding those who cause the most damage. Bankers came to mind. I have nothing against them per se, but even when they’re not causing global financial melt-downs, is making profits from moving commodities and hot-air around the world really as important as looking after us when we are at our most vulnerable? Right then, I thought not, and it’s an opinion I haven’t changed.

My rehab-proper started in the afternoon, with visits from physio and occupational white man and crutchestherapists. The physio measured me for a pair of crutches and demonstrated the correct way in which to use them (you can crutch incorrectly?), while the OT asked me questions about who I lived with (yes, there were two able-bodied people at home to look after me), whether we had stairs (two, down to the bathroom), and about the type of work I did. Being up would be good for me, she said, and arranged for a comfortable chair to be put by my bed. Unfortunately, this back-fired; as the day wore on, my cast started to get tighter, and during one of the frequent nurse-checks of the state of my foot, I revealed that it was a bit numb. I didn’t think it was a big deal, but the complaint got escalated. A more senior nurse appeared and went away, followed by a doctor. Eventually, the consultant came. He was cross to see me sitting up and told me to get back into bed. “Cut the cast,” he told the nurse. To me, he said that my leg was swelling because it wasn’t able to pump blood properly, and that it was really important that I keep it elevated. So back to bed it was. The cast was cut down its length to ease the pressure, and what seemed like half a dozen pillows were propped underneath me, holding my leg in the air. Later, they were replaced by a mean-looking metal contraption.

My personalised crutches (the physio had put layers of soft tape over the hard plastic handles) arrived the next day. Thursday. My fourth day in hospital. I was champing at the bit to get out, so I launched into crutching with enthusiasm. Too much enthusiasm. It’s harder than it looks, especially if you have no sense of balance any more, and are travelling over highly polished hospital floors. My wild swaying scared the bejesus out of the nurses on my first foray, to the bathroom and back. I was put back to bed and told that on no account was I to go crutching on my own just yet.

Overall, though, things were getting better. I could now shower and dress myself (except for the knickers – that remained a problem for months), and was feeling altogether more civilised. I chatted to visitors (mine and other people’s), sent texts near and far, and snoozed like a cat in the afternoon sun.  That night our entire room got an almost-decent night’s sleep, possibly because we had all been there for a few days now and were starting to settle into the hospital’s beat. I had started to feel quite fond of my roommates and realised I would miss them. But that didn’t mean that I wasn’t determined to leave, the next day if possible.

Friday morning saw me on the phone dictating instructions to Sandy, who was putting out my weekly sustainable business magazine in my absence. He had offered to bring my laptop in so I could work, but I demurred. Instead, I begged some paper and a pen from a doctor, sketched out a story in the old way, and fired it down the phone to Sandy, who was taking copy (as we used to call it) at the other end. To be filing a story from my hospital bed didn’t seem in the least bit strange to me; I did, after all, file for the New Zealand Herald four days after my baby was born. It’s what I do. But what was strange was how much writing a short story tired me. I’ve been writing for more than 30 years, and can do it in my sleep, so to speak. Once I have identified the guts of a story, the words flow out of my brain and on to my computer almost without me being aware of them. But this story – about how the company Foodstuffs was using natural refrigeration in some of its supermarkets – made me work.

Later, the physiotherapist returned for my next crutching lesson – stairs. The hospital has a mobile wooden unit with two steps on each side, which it uses for training crutch novices. The technique is quite specific and counter-intuitive; going up – balance on your crutches, move your bad leg up, your good leg up and then the crutches. Going down – crutches, bad leg, good leg. The physio watched me closely as I practised, and eventually ruled that I was fit to be let lose into the world.

I had another session with the occupational therapist as well, planning and practising how I would get in and out of the shower. Our shower is over a bath, so she arranged for Sandy to pick up a long stool that I could slide along until I was under the water. She also provided plastic bags for my cast, and a frame for the toilet.

That just left the medical clearance. Sandy and Tom arrived while I was showering and changing into my going-home clothes, and we sat around together waiting for the final ok. The consultant had told me during his morning rounds that I would be allowed to go, but the Is still needed dotting and the Ts crossing. Eventually, we got the paperwork and I got my crutches ready, only to find myself bundled into a wheelchair. The orthopaedic ward is on the fourth floor of the hospital, and the nurses said that “walking” to the lift and taking it to the ground floor would be too much for me just yet. So I left the hospital in a wheelchair, my crutches slung across my lap. Sandy brought the car to the front door and I slid into the back, where I leaned against the door and draped my legs along the seat. “Take me home,” I said, and they did.

*I would love to hear from you – please send me a message  or leave a comment below with your thoughts, comments or experiences. And if you think it anyone else will find this useful or interesting, please share using the buttons below.

 

Wasted days and wasted nights

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‘Now I was a pile of wreckage in a place I didn’t want to be, and I was going to have to admit what had happened’

Adelia Hallett continues her story about life in the pain lane with a smashed leg (see part 1 and part 2)

Monday, November 25, 2013: It was a long night, despite being more than half over by the time I got to bed.  Nurses woke me to check my pulse, ask me about my pain levels (eight, on a scale of one to 10, bearing in mind that I’ve given birth and had gallstones), and to administer drugs. The cotton wool given to me to put in my ears when I came

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A hospital bed is not the place I planned on being that day

up from Accident and Emergency helped to block out some of the noise, but was no use against the bright lights and throbbing engines of the emergency helicopter landing on and taking off from the helipad on the roof below the ward windows.  At some point, another patient was moved into the bed opposite me. It took a lot of staff, and, from what I could hear, equipment, to lift her on to the bed, and, judging by her cries, she was in even worse pain than I was.

Inevitably, the tea I’d drunk in accident and emergency caught up with me, and my bladder sent me a message to do something about it. Lesson one in life without the use of one of my legs; even the most rudimentary aspects of looking after myself were now a hurdle. It was getting on for dawn, and the nurses were black shadows buzzing through the grey light. I called one over, told her my problem, and she got me a bedpan. I had never used one before, but needs-must, and I gave it a go. I mightn’t have positioned it properly, or my bladder might have been so full that it exceeded the bedpan’s capacity, but urine seeped up the back of the hospital gown I was wearing and soaked the bed. 

It’s hard to explain how helpless and humiliated I felt. It was worse than lying in the paddock calling for help. There was, at least, a certain nobility to that; I was a fallen warrior. Now, I was a pile of wreckage on a bed in a place I didn’t want to be, and I was going to have to admit what had happened and ask for help. The nurse who answered my bell was kind. Perhaps she could see how close to tears I was. Perhaps she had seen it before. She got me into a clean gown, changed the sheet, and gave me a cloth to wash my face with. I felt better. The ward had gone quiet, there was a lull in helicopter traffic, and I slept.

Life looked brighter when I woke the next time. It was morning proper, and sun was coming in through the windows. The ward was bustling with activity. Jayne, who had been stranded at the hospital with no way to get home and had been given a bed somewhere, sneaked in with her teddy bear hot water bottle under her arm to see how I was and to tell me she was going home. I rang Sandy to say I was still alive, and at 7.28am fired a text off to close family and friends, letting them know what had happened: “In hospital, horse stood on my leg, might operate today”.  I hadn’t realised before how cheering get-well platitudes could be. A gratifying number of texts fired back at me, and my sister and my stepmother (a nurse) rang immediately.

By now breakfast was being served, but I was nil-by-mouth. I took it stoically; I naturally have low blood-sugar levels, and missing morning or afternoon tea, let alone a major meal, is usually a major drama for me. But there was good news to come. Into the morning chaos came the doctors on their rounds. I was prodded and poked and asked about my pain level (down to 7.5), and then the consultant – the big guy – arrived. He told me a lot of things which I didn’t really take in, about my injury and how he planned to treat it, but what I did understand was that he said I could have breakfast, as my operation wouldn’t be performed until late in the afternoon. Yes! The gluey porridge and soggy toast the nurses managed to rustle up for me (when the breakfast orders were done I had still been gloriously injury-free, with no intention of needing a hospital breakfast) were surprisingly palatable, and the tea had the power to right the world’s wrongs. Or at least mine.

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The healing powers of tea should not be underestimated – especially in hospital

Sandy and Tom arrived shortly after breakfast, with a bag of things from home. Sandy was smiling but Tom looked anxious. He patted me a few times, then launched into an explanation about how the radio and headphones he’d brought me worked.  I filled them in as best I could on what the doctor had said, and said I thought I might be home on Wednesday.

After they left I drifted. I didn’t feel like reading, and while I said hello and exchanged brief medical information with my roommates, I didn’t feel like talking either. At some point I heard one of the women telling a visitor that they missed the previous occupant of my bed, who had apparently been quite chatty. “I think this one must be in a lot of pain,” she said.

Shortly after three, a nurse came and told me that I was “going down next” to theatre, and started to prep me. Then she left. Fifteen minutes later she was back with the news that I had been bumped off the surgery list for the day. Something more urgent had come up. I am a great supporter of our creaking public health system, but at that moment I cursed it. Inwardly, of course, but with venom. My head understood the concept of treating the most urgent cases first, but the rest of my body didn’t. It was broken and sore, and crying out for attention. On the up side, I could eat again, and it was only a short wait until dinner at 5pm. Then I settled in for what would turn out to be one of the longest nights of my life. Longer than the previous night, with all its drama, and longer even than the night my son was born. Both of those nights had been filled with events. Things were happening, and I was heading towards resolutions.

This night was just long and lonely. I tried to sleep, but it was elusive. I read for a bit, but my brain wouldn’t concentrate on the story. I listened to the radio. But most of the time I just lay there. A couple of my roommates were also having bad nights, and there were repeated flurries of nurses in and out of the room. I felt sorry for all of them – patients and nurses. The patients needed help, and there weren’t enough nurses to give it to them. My brain wasn’t sharp enough to grasp the details of what was happening, but I did pick up the sense of desperation coming from the patients, and harried compassion from the nurses. They called colleagues from other parts of the ward to help them give my room-mates the attention they needed (nursing is a surprisingly physical job, sometimes requiring three or so to do what needs to be done for a patient). That left a shortage in other parts of the ward. Bells rang. Nurses ran back and forth. I tried to lie quietly, knowing that my needs weren’t as urgent, as compelling, as overwhelming.

But overwhelm me they did. Some time in the night I pressed the bell. The activity around the bed opposite me was slowing. A nurse peeled off and came over to me. I told her that my leg was really sore, and to my surprise I found tears running down my face.

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The morphine pump – my new best friend

She was kind. Motherly, even though she was younger than I was, and (I later found out), didn’t have children. She soothed me. She made the night seem less endless. And most importantly she gave me strong painkillers and told me that I should be using the morphine pump attached to my arm every 10 minutes or so. “You can’t overdose on it,” she said, “it won’t let you. But you need to keep on top of the pain.”

And so another night passed. Once again the morning seemed more cheerful than the night had, and I knew the drill. The doctors appeared again and assured me that I would be operated on that morning. I was changed into a surgical gown, my jewellery was removed (for some reason, the ring I was wearing was taped to my finger), and I was loaded on to a gurney. “Good luck,” my roommates said, and I gave them a thumbs-up.

Down in the theatre suite, the orderly who was pushing me told me that he also worked as an ambulance officer, and had heard my accident called in. People introduced themselves and explained again what they were about to do to me. I told the anaesthetist that I tended to vomit when coming around (he made a note), and I admired the theatre lights, which, from my prone position, looked sculptural and space-age. “We get them at Lighting Direct,” one of the surgeons quipped. And that’s the last thing I remember.

Next post – The Recovery  – posted soon

*If my belief in the curative powers of tea seems naive, think on this: researchers are investigating whether the humble cup of tea could combat killer infections like anthrax and hospital superbugs.

I would love to hear from you – please send me a message  or leave a comment below with your thoughts, comments or experiences. And if you think it anyone else will find this useful or interesting, please share using the buttons below.

 

Life in the pain lane

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Whangarei Base Hospital accident and emergency department, sometime before midnight, Sunday, November 24, 2014.

Life pivots around events that take place in seconds. Split seconds. A chance meeting, a lottery win, an accident. Events that take us and hang us upside down and shake us until the change falls from our pockets and our brains turn dizzy, and our sense of who we are and what we are is so thoroughly turned out and dusted that we can never be the same again.

In New Zealand, a quarter of us are disabled. According to official figures, in 2013 (the year in which I had an accident), more than one million New Zealanders were coping (or not coping) with some form of long-term disability. That’s a lot, when you consider there are barely 4.5 million of us in this country.

As you’d expect, impairment is most common in the elderly (59 per cent of those aged 65 or more). But don’t think that we middle-aged folk get off lightly; 38 per cent of those of us aged between 45 and 64 have some form of long-term impairment (lasting more than six months and affecting our ability to function). And disabilities affect 16 per cent of young adults (15 to 45) and 11 per cent of children.

The numbers are scary. One in every four people you meet is dealing with something. If you go into a school, every 10th child – that’s three out of a classroom of 30 – has to overcome some sort of hurdle (in the young, hearing, learning and psychological issues are the most common form of impairment) before they even start the day’s lessons.

Disabilities come in all shapes and sizes. Hearing loss, blindness, developmental delays, psychological impairment, memory loss and intellectual impairment are all common disabilities. But among adults, at least, it’s physical impairment, caused by accidents or illnesses, that is the biggest problem.

Less money in the bank

What surprises me is that I’m one of those statistics. If you’ve been fit and healthy most of your life, you don’t expect to suddenly not be. You know you’ll slow down as you get older, your eyesight will fail and your muscles will wither, and you’ll probably need people to help you with some things, but you don’t expect to lose your fitness – your physicalness – in an instant.

The event that changed my life was a horse-riding accident, an occurrence so small in detail that sometimes it’s hard to trace the line that runs directly from there to here.

Admittedly, the accident came at the end of a tough year, and just a few weeks after I’d been made redundant from a job I loved, so I’d already drawn pretty heavily on the emotional, physical and financial capital I had in the bank.

Nevertheless, I expected to get through an accident in much the same way as I got through everything else, by hanging in and working hard. I didn’t imagine that a seemingly inconsequential decision, followed by a split-second occurrence, would spark a chain reaction that would turn the world upside down.

Unplanned and unwelcome

Neither did I realise that I was about to become a person I would despise – dependent, whiney, incapable and weak, who would make dreadfully bad decisions and fail at some critical moments.

Moving from the world of the “able” to the “dis-abled” (interesting that the “dis” form of the word always takes the past tense) was unplanned, unwelcome and unnerving. Part of me sought to divorce itself from the process and watch it objectively, so that I could write about it, because writing about issues, but also experiences, is what people of my ilk (journalists) do. But to my surprise, I couldn’t do it. I wasn’t up to it. The ball of energy I had rolled through life on had been kicked into touch by my beloved horse’s stumbling legs, and I no longer had what it took to do what for me is the simplest thing on Earth – write.

Obviously, this had implications for my working life, and therefore my family’s income. For nearly two years I tried to push myself into working, because the ramifications of not working were too awful. And besides, it’s what people – including insurers – expected me to do. But it wasn’t until I stopped trying and gave myself the time and space I needed to get better that I started to make progress.

New Zealand is blessed to have a publicly funded health system (albeit a creaking one) providing free care for its citizens. We also have a full-cover, no-faults, national accident insurance scheme, called ACC. But the fact that, as a society, we show enlightenment about healthcare and insurance doesn’t mean that we don’t also have an attitude about “bludgers”. That is, in fact, what has finally made me set fingertips to keyboard; a few days ago I saw a bitter little post in a Facebook group about a person who was on “disability” (the poster probably meant getting ACC payments because he was unable to work because of a disability) but that didn’t stop him painting the house or going out.

We’re put here to work

It was heartening to see some people gently rebuke the poster for jumping to conclusions, or for taking the attitude that if you are unable to work, you shouldn’t do anything at all, but the majority of the comments took a hard line. Rehabilitation is not an instant process but a continuum; you aren’t disabled one day and at full strength the next. Our bodies take time to repair and then to build up strength again, and getting active around the house and going out is an essential part of that.

I know this from hard experience, and yet curiously, as I wrote these words I began to feel anxious about what people would think, because the work ethic is such a part of our culture that to be seen to lack it or doubt it is to put yourself outside the culture.

What I needed when I was injured was to be told that everyone is different and that the road to recovery is long and full of pitfalls. I also needed to know what practical issues I would face.

When I left the hospital, I asked for a brochure on what to expect. The staff told me there wasn’t one. This, then, is my attempt at a brochure, a user’s guide to having a broken leg, as it were. As I have time (I am now back at work full-time, so there was a happy ending), I will write posts about what I experienced and what I learned in case it’s of help to anyone else.

Please also feel free to ask questions or share your experiences.