Chapter 34

Acetabulum

The Curious Incident of the Dog in the Park

Animal, vegetable or mineral?   Some star in a distant constellation?

I hadn’t any idea what an acetabulum was, but I was in the process of being advised by a smart young guy that he was a bit worried about mine.

‘Give me a clue,'  I winced,  'and I’ll have another dose of that morphine please!’

‘Well, most people would call it the pelvis and, whilst it’s not exactly clear on the X-ray, it seems like you might have fractured yours…in several places actually.’

Any hopes that I might have been clinging on to that all I’d done was severely jar my groin ligaments and badly bruise my hip dissolved into the sterile, antiseptic air.  My initial action plan of being allowed to limp out the hospital later this afternoon and recover at home dissolved along with my optimism.

‘I’m arranging for a proper CT scan, someone will collect you shortly. I’ll be back when we’ve had a closer look. Oh, by the way, I’m afraid that’s not a sprained wrist; you’ve broken the radius bone in your forearm as well.  We’ll also just double check there are no other breaks around your shoulder and then we’ll get your scrapes cleaned up and put that arm into plaster.’

I was momentarily speechless as I watched his white coat sweep out of the door.

So, there I was, in Southmead A&E, lying on my back as instructed, and trying not to move too much.  Clad only in my cycling shirt and shorts, both torn and leaving most of one hip exposed, I attempted to ignore my growing thirst.  (All liquids had been forbidden in case I needed an op.’)  I was sore from scraping my arm, shoulder, leg and hip along the tarmac, and I felt as if I’d been kicked in the groin, right at the top of the leg.  However, whatever painkiller I’d been given was taking the edge off the pain and it was all pretty bearable, although I did really need the loo, but walking was impossible and my right arm was in a sling.  Nurses were checking my blood pressure and temperature every few minutes and asking how I was feeling.  Now, I don’t mind a bit of attention, but this struck me as either excessive or ominous.

Sue was trying to organise how she was going to get home, change, arrange for the bikes to be picked up, and return later and it was also just dawning on her that we might just have to change a few plans in the coming days.

What do you do when you can’t do anything and are 100% in the hands of NHS staff?

You wait for something to happen and try to figure out how a leisurely Saturday ride to Clevedon had ended up in A&E.

Saturday 19th July 2014 - the forecast was good and it was the perfect opportunity to do a ride we’d had on the list for ages - country lanes to Clevedon, cake and coffee at a cafe on the front, and then back by a different route.  No rush, no big hills: a mere jaunt.  So, after gathering some supplies, we headed out towards Ashton Court. The sun was high in the sky and we were down to t-shirts as we cycled up past the house in the park where there were few people milling around, although I vaguely registered a family group on the crest of the road before it fell gently towards the south-western gatehouse.  The road ahead was clear and empty: perfect for a gentle free-wheel!  But as we gathered speed, I caught a fleeting glimpse of a ball bouncing on the grass to my left, before:

‘THUD!  CRACK!  SCRAPE!  WTF ?!!!’

I was on my side.  The bike was a few metres further on.  The slide along the tarmac was over, but shock and pain receptors were going off everywhere as I tried to process what had happened.  I’d had a few crashes over the years but I recognised this was different and I lay still for a few seconds, trying to catch my breath, before starting a tentative initial damage assessment.

Sue arrived as I was beginning to sit up and drag myself onto the adjacent grass.  My head seemed clear enough, so no damage there, but I was baffled! 

‘I’m going to need a few minutes.  Did you see what happened?’

Members of the family we’d just passed were beginning to gather round; the dad, mum, small child, grandmother and a young black Labrador trying to get in on the act.  Concerned, apologetic, curious…

The answer to the ‘WTF’ question was quickly pieced together:  Dog running around on the grass on one side of the road; ball thrown by the dad to the other side of the road; excited young dog takes off on a direct intercept route, oblivious to anything that might be in the way; cyclist rolling down the road doesn’t see the dog as it barrels in on his blind side and makes a direct hit on the rear wheel;  bike knocked into the air before stunned cyclist and bike bounce along the road and separate; dog surprised, but uninjured and keen to get ball;  cyclist sitting on the grass, checking himself over.

Preliminary Damage Report:

Shoulder:  scraped and bruised and beginning to sting; bit of blood but should be fine once it’s cleaned up.

Elbow:  ditto.

Arm:  wrist ‘looks’ right but doesn’t ‘feel’ right - it’s aching and trying to clench my hand gives me a painful stab.  Might be a bit tricky using the brakes later.

Leg:  knee looks okay but there’s some serious road rash on the hip and bum - shorts are torn and it’s going to take quite a few wet wipes to clean the grazes.

Groin: this is an odd one - feels like the saddle or something must have jarred the ligaments at the top of my leg.  Hopefully the pain will ease in a few minutes and I can get up and walk it off.

‘I’ll just have a couple more minutes.  Can you pass me a drink?’  I remained seated.  'Does the bike look okay?'

The little group was still gathered around, trying to be as optimistic as me that we could all soon be on our way again, although my subconscious was beginning to rationalise and focus more on getting home to Downend than carrying on to Clevedon.  When the initial stinging from the road rash wore off, I gratefully took Sue’s hand and levered myself up on to my feet, favouring my good left side, but quickly realised that transferring weight onto my right leg would be another matter.

'Don’t do it!’ screamed my body’s warning systems, but my head overruled it.  ‘I need to know, and I can’t stay sitting here.'

I gasped at the sharp kick of pain in my groin and hip as my leg nearly gave way.

‘Em..I’m going to have to sit down again.’

I was aware of beads of sweat prickling on my brow, but was equally conscious that my language had to be sanitised for the benefit of the child and granny who were still staring at me anxiously.

‘Think I’ve torn some ligaments and might need to get my arm checked.  Sorry, but I don’t think I’m going to be able to get back on the bike today.'

‘I think you might need an ambulance,’ suggested Granny, and Sue agreed.  We’d been there for at least a quarter of an hour and it was time for a decision.  I’d never been in an ambulance in my life, but as I wrestled with the effort of trying to ease the now considerable discomfort I was in, I realised a trip to A&E was inevitable.  Granny dialled 999.

It was cloudless, windless and hot.  The shade of some nearby trees was too far away from me to offer any relief.  Sue and the dad discussed tactics and exchanged phone numbers. Granny was dabbing at my shoulder and elbow with some felicitously found wet-wipes whilst tentatively offering to replace my torn shirt and shorts, but a response to this was beyond me.  Sue reassured me that the bike hadn’t sustained any major damage.  Apparently, the right hand levers were bent, the chain was off and there were some new scratches.  I was worried about the front and rear gear mechs - had they been damaged?  And what about the frame?  It was carbon so may have been cracked.  My worries were interrupted by the familiar wail of an ambulance in the distance and, although it seemed to be coming our way, I wasn’t really sure I was urgent enough for a siren, but then the noise stopped.  By then the effort to contain both the pain and my swearing was becoming too much.  I just wanted the paramedics to arrive!

A distant green figure appeared on the road that leads up from the Western Gate. Why was he on foot?  A few minutes later a large, round paramedic, red in the face and sweating profusely, arrived.  He had just tried to jog half a mile in full uniform and carrying a large kit bag.

‘Hi, I’m Dan.  Sorry we’ve been a bit delayed but we can’t get the ambulance through either of the gates.  They’re locked and the people at the cafe don’t know what the codes are.  Now, what’s your name mate, and can you tell me what happened?’

If you’ve ever watched any TV documentaries that follow an ambulance crew, then you’ll know how the next few minutes went.  A reassuringly calm initial assessment from head to toe and a steady stream of questions on how I was feeling and what my levels of pain were.  He was a bit of a character and quickly established a rapport with the waiting group as we all awaited his verdict.

‘Right.  Firstly let’s give you something for the pain - just a small dose of morphine.’  He produced a syringe and jabbed it into my arm.

‘Now I think we need to take you to hospital to get you properly checked out. I’m afraid it’s quite possible that you’ve broken your arm and I’m a bit unsure about your hip and pelvis, so we’d better be safe than sorry. Those grazes are going to need some attention but I don’t think you’ve got anything to worry about with your head.’

He was on the radio and I heard the word ‘helicopter’ and then, just as he was in the middle of suggesting we might need an air ambulance, he received a call to tell him that the cafe had phoned the boss at home and obtained the gate codes so the ambulance would be with us in a couple of minutes.  Sure enough, it duly appeared over the brow of the hill, but the driver was frowning as she announced that the vehicle, which had been parked in the hot sun for about an hour, had been overheating whilst waiting for the gate problem to be resolved and there was now steam coming out of the bonnet!  Fortunately, she had been so concerned that she had already called for back-up and, whilst we awaited its arrival, they decided to get me onto a stretcher which sat on the trolley they’d unloaded.  I was helped to my feet and manoeuvred adjacent to it before being eased back into a lying position, resting partly on my elbows.  For some reason I didn’t want to lie flat, perhaps worried that I might have been excluded from the conversations about my immediate future, or that it might send a signal that I was worse than I actually thought.

As we waited, I was told that I couldn’t have anything to eat or drink, which irritated me bit but concerned me even more.  However, just before we all finally melted, the second ambulance appeared. Four paramedics, two ambulances and a crowd of curious bystanders:  I felt like a celebrity and briefly contemplated a wave as they loaded the trolley into the new vehicle.  Except they didn’t!  Apparently, the first trolley wasn’t compatible with the second ambulance.  Finally, I was swapped over before finally being successfully loaded. I managed a heartfelt thanks to Dan, the world’s fattest paramedic who was up from Exeter to cover Bristol for the weekend, (that run from the gate was probably the furthest he’d managed for year,) and a ‘hello’ to the new crew.

Sue clambered in after me, having made some arrangements for bike recovery, and I was hooked up to a drip as our mini-convoy of two ambulances pulled slowly away. 

‘Okay, where do you fancy going?' asked the driver, as though wondering about our preference for a restaurant. 

‘BRI?”  (Closer)  Or Southmead?’  (More convenient from home).

We hadn’t expected a choice but readily went for the convenience option and, with the benefit of hindsight, for reasons which will become apparent, this was fortunately the right call.

‘Good that suits us!  We’ll get you straight in at this time of day!’  And sure enough, on arrival, it was straight through the emergency doors, past the waiting areas, and, just like in Casualty, into a curtained-off cubicle where three of four staff made the transfer from trolley to hospital bed.  It really is like you see on Casualty when the A&E team turns their focus onto you. The paramedics hand you over with a brief summary: ‘This is Pete, 55, cycling at about 15 mph when knocked off. Sustained grazes and complaining of pain in the pelvic area and forearm. Unable to walk.  One dose of morphine. BP and HR appear okay.’  And then they disappear wishing me ‘all the best!’

The nurse attached a few sensors, the doctor shone a light in my eyes, listened to my chest, checked for responses in fingers and toes, and asked a range of questions about how I was feeling.  She was quite young but seemed to know the drill and told me that, as soon as they were happy my blood pressure was stable, they would get me over to X-Ray to assess the damage.  Within half an hour, I was on my travels, being wheeled through the maze of corridors by one of the army of rotund porters, and straight into one of the X-ray rooms, where the radiologist rounded up a few pairs of hands to help transfer me from bed to bench. They seemed very keen to minimise leg movement and I had to remain immobile.

‘Okay, Peter.  Lay your arm here. I’ll do that first. Just lie as still as possible.  We’ll clear the room but you’ll be able to hear me over the speaker. It won’t take long. You’re not wearing anything metallic are you?’

I was left alone, lying on my back, whilst overhead the machine, resembling a laser gun in a science fiction film, silently glided into position, paused for a few moments, and then moved on to get a subtly different perspective.  It was all over in ten minutes and we trundled back to my cubicle in A&E.  Apart from the regular quick BP and temperature checks, Sue and I were largely left alone for the first time in a few hours. She had managed to get a coffee, had confirmation from the ‘dog family’ that our bikes were safely stored at the Ashton Court café, and had called on Dee and Andy who were coming to the rescue to take her home.  She’s usually pretty good at accepting changes in circumstances when there’s nothing you can do about it; better than me that’s for sure, and was probably already beginning to realistically realign our calendar for the next week or two.  If she was worried, she wasn’t outwardly showing it.  I suspect she was just relieved that I was where I needed to be.  We decided she might as well pop back home and return later when there might be more news.

With a few minutes to myself, I was beginning to get my head around the situation. Clearly, what I had hoped would be no more than an inconvenience, was morphing into something with more serious implications.  My internal dialogue of 'f…ing dogs and f…ing dog owners’ was at odds with my more stoic side.  I knew it was hard to blame the family too much for what was clearly an unfortunate accident. It was a park.  Dogs needed to be allowed to run around.  But for Chrissakes!  Throwing a ball where there are cyclists!

The clean-up squad arrived: a nurse armed with a pair of scissors and wipes.  Within a couple of minutes my shirt, shorts and gloves were removed and tossed into a bag and I was being helped to carefully wriggle into one of those hospital gowns, open with a tie at the back: practical but not very flattering!  The grazes were cleaned and dressed, which stung, and I also realised just how much of my right side had taken a scraping.  Modesty had to be abandoned, as I was eased slightly onto one side so my buttock and hip could be treated.  I asked about a drink and mentioned I need the loo.

‘Sorry, Peter. Until we know whether you’re having surgery, it’s nil by mouth. But I can get you a bottle.’

True to her word, I was duly presented with a grey disposable cardboard pulp bottle and wasn’t sure whether to be embarrassed or proud when I filled it almost to the limit (875ml) and then had to be super careful removing it to the bedside unit with my left hand, a manoeuvre I was going to have plenty of chance to master over the coming weeks!

As I reluctantly accepted that I would certainly be staying in overnight and was unlikely to be able to get to work on the following Monday,  I further developed my left-handed skills by pinging off a text to Giuseppe: 'Had an encounter with a dog whilst cycling and came off second best. Currently in Southmead for a day or two so doubtful I’ll be in Monday. Will call when I know more.’  I refused to indulge in any pessimistic thoughts and seemed to have put a mental block on speculation beyond the next few days, but it wasn’t easy.  However, the pain in my pelvis seemed to have eased, and a broken arm wasn’t that big a deal.  Was it?

We were off again: the same porter but a different room, different radiologist and different team of four to transfer me onto the sliding table that protruded like a tongue from the mouth of the cylindrical scanner.

'It won’t take long, but please lie still.’

I was sucked inside and was aware of an eerie quiet - no hammering noise like you get in an MRI scanner.  It was soon over and we were barely back in A&E before the doctor arrived to deliver the CT verdict.  His face was calm but his message was grim.

‘So….. what we can see on the scan confirms that you’ve badly fractured the acetabulum.  The orthopaedic doctors will decide the next steps and it’s going to mean you’re with us for a few weeks.  The hip and shoulder seem to be okay and the break in your arm is clean.  So whilst we sort you out a ward bed, we’ll get the arm into plaster.  I’m not sure who it will be but an orthopaedic consultant will see you later.  We’ve got a great team here, with world class specialist skills on pelvic injuries, so you’re in the right place.  Good luck.’

Less than half an hour later I was installed in my new accommodation: my own room with en-suite shower and loo.  The door opened onto a wide corridor so I could watch people walking by and there was a pair of chairs by the window that looked down onto the large, bustling main concourse of the hospital.  A couple of the ward nurses popped in to say hello and fix me up with a morphine drip, which I could control with a button, and show me how to operate the various features on the bed.  It was quite comfortable and had a control panel that enabled all sorts of adjustments. They gave me some clear instructions: ‘You’ve got to stay on your back so don’t even think about trying to move yourself.  Just press the call button if you need anything. Someone from musculoskeletal will be along soon.’

With some time alone in relative physical comfort, I allowed myself a tentative mental foray into what the immediate future might look like.  How would I work from here?  Was there any wifi?  The Yorkshire holiday was off the table, and racing was out for the season.   ‘F…ING DOGS!’  ‘Bugger, bugger, BUGGER!’  The balance between, 'It was an accident, these things happen…' and, ‘F..ing dogs’ was sliding quickly in one direction as more of the implications started to become apparent and I was finding it increasingly difficult to affect a cheery façade whenever a member of staff looked in.

At around six, Sue made a welcome return.  She had gathered together a few things I was going to need: Wash kit, t-shirt and pyjama shorts, i-pad and a couple of books. She was going to pick up the bikes the following day and had spoken to Dad and her parents.

'Still don’t know if I’m going to face an operation this evening or in the morning. Hopefully, the doctor will be along soon and we can find out what the plan is.'

We started going through a few lists: people to contact, things to cancel or rearrange, insurance actions and so on, when a familiar face appeared at the door.

‘Peter!  My dear Peter!  You crazy guy!’ and in walked Giuseppe Zichella.  At least my being hooked up in bed prevented him from giving me his usual exuberant Italian embrace!  I was impressed and slightly overwhelmed. It had only been a few hours since I had texted him. He had obviously dropped what he was doing and come straight here. He’d even bought a box of Ferrero Roche. By the time he had kissed and hugged Sue and found himself a chair, I was back in control.  We gave him the story, the first of many, many repeats to come, and ignorantly speculated between us on likely outcomes for the next few weeks. It was only a week before the factory closed for a fortnight but, as usual, there was loads of stuff that would need to be sorted, so we attempted to identify the critical things for the next few days and discuss who could pick them up.

‘If one of the guys can pop in with my work lap top I can keep an eye on things from here.’

I knew I wouldn’t be able to relax without pulling a few control strings and GZ didn’t bat an eyelid - he’s got the same work and commitment genes and saw this as perfectly normal.  After a few more minutes chatting, he was on his way, followed shortly afterwards by Sue. There was nothing else she could do and it had been a long, hot stressful day for her too, so a sit down with a glass of wine was well deserved.

Apart from being ravenous and thirsty, I wasn’t feeling too bad.  There was no TV in the room so I experimented with the wifi, expecting it to be useless.  Bingo!  There was a really strong signal and I could pick up i-player and Sky Go without any buffering. Things were looking up!  I was in my own room with Le Tour, the Test match and some box-sets to keep me entertained!  I was just beginning to think I’d been forgotten when a young guy strolled in and introduced himself as James Murray, one of the musculo-skeletal team.  He was chatty and relaxed and delivered the latest setback in a positive way.

‘The good news is that you seem to have avoided any internal bleeding. There are some key blood vessels that pass through that area and sometimes, if they get damaged, it can cause severe blood loss. During the Middle Ages and really, right up until the last century, this was the main cause of death for the aristocracy.  They’d fall off their horses, think they’d only bruised themselves, hobble around a bit and then drop dead a few hours later for no obvious reason. Your paramedic was spot on by the way.  He did exactly the right thing by stopping you moving and we’ll keep a close eye on your blood pressure for the next few days.

Your arm doesn’t look too bad - might need a plate, but I don’t anticipate any complications.

The challenge is the fractures to the lower half of the acetabulum. It looks like crazy paving where the ball of hip bone has been smashed into it. My boss will decide on how and when the surgery is best done. He’s in tomorrow morning so he’ll come and see you.  He’s good, so you’re in the best hands.”

Blimey!  I had had no idea that these things could be fatal!  And I still had some burning questions.  The obvious one: ‘How long do you think I’m going to be in for?’  The one I was almost too afraid to ask: ‘How long till I’m active again?’  And the one I really wanted resolved: ‘What about marathons and Ironmans?’  I knew the last one was premature, but it was the one that was bothering me the most.

‘Probably a fortnight with us and then, if the rehab goes okay, I’d say six months to be up and moving properly again. You could be doing light running by early next year.  Swimming will be easier so back in the pool as soon as you can walk.’

‘SIX F…ING  MONTHS!'

I turned my attention to more immediate matters. ‘Can I eat or drink now if there’s no op tonight or tomorrow?’

‘No problem for now, but nothing in the morning until the Boss has seen you.  I’ll also be around next week so I’ll probably catch up with you then.’

It was too late to have the evening meal but one of the nurses kindly found me a coffee and a piece of cake from somewhere and I was left alone.  With nothing else to do, I eventually succeeded in removing my lenses with my left hand and experimented with the layout - bed position, morphine button, room temperature, glass of water, phone, ipad, specs, pee bottle, book - before settling down to watch some TV.  Eventually I called it a day and prepared for my first night in hospital since I had had my tonsils out aged six.

It wasn’t the greatest of nights.  I could just about cope with having to stay lying on my back and the odd squirt of morphine helped offset the pain, but it was hot and sticky, and every few minutes an alarm, buzzer or phone went off somewhere outside my room.  It seemed as if the nursing staff continually had to deal with some very vocal patients.  Every couple of hours I was woken anyway to have my BP checked and temperature taken. Clearly this was necessary but it made sleeping difficult. However, morning came at last.

Despite the good fortune of a private room, I was woken early by the general noise and activity in the ward. It was an enforced Sunday morning lie in, but without any breakfast in bed.  My peeing-in-the-bottle technique was improving, but shaving and even washing and teeth brushing were awkward and uncoordinated.  Sue phoned and assured me she was planning on coming in later.  I asked her to dig out the British Cycling accident reporting documents.  Wishing the consultant would show up and deliver his prognosis and action plan, I was happy enough with the radio, the internet and a book, but was starting to recognise that, without some sort of target, I get edgy pretty quickly and I hadn’t even been in there for 24 hours!  There was a steady stream of other NHS personnel popping in: bustling, chatty auxiliaries to clean the room; catering ladies to offer drinks; the next shift of nursing staff to check my vitals and medication; by mid-morning I’d repeated the ‘Dog in the Park’ story a dozen times.

‘Ah, good,' I thought. ‘This’ll be him,’ as a chap in his fifties, maybe sixties, came in. Oddly, he actually knocked on the open door, a nicety not usually observed on the ward, and he was dressed a bit smart-casual, wearing a jacket and tie.  Perhaps he was off for lunch or something later?  I hoped he hadn’t come in to work just to see me.  And then I tried to hide my disappointment when I discovered he was the hospital chaplain and was kindly offering some of his time if I wanted to chat or pray with him.  He’d probably developed a sixth sense that quickly spots someone who, in normal circumstances would welcome a theological debating challenge, and doesn’t push it beyond wishing me good luck before heading off to find a more receptive individual. It’s not my bag, but I can appreciate that there are probably a fair few patients who would welcome some time with him, and I wondered how it works with other religions?   Was there a hospital Iman, Rabbi or Druid?

Finally, Consultant Orthopaedic surgeon, Mehool (Mez) Acharya, and a female Junior Doctor arrived and got straight to the point.  They were going to rebuild the pelvis and the operation would be on Wednesday when he could next get his full team together.  Apparently, it was going to take about five hours so, in the meantime, they would need to do some more checks on my overall health and obtain further scans of the damaged area. He was reassuringly confident but deftly deflected questions about recovery timescales.  He would ‘have a better idea after the op’.  He was, however, happy for me to sit up rather than just lie down and, provided a nurse helped me, I could spend some short spells in a wheel chair or (more importantly) sit on a commode.

‘Get plenty of rest and I’ll see you again on Tuesday.’

The good news was that I could now get seriously tucked into the hospital menu and, having missed breakfast, I was ravenously looking forward to lunch.  The bad news was that I had three days to wait before the op and the start of the fight-back.  I flitted between the Test match, Le Tour and some casual web surfing, before Sue appeared with Dad in tow. He had driven over from Wales and they’d come in together.  She had collected the bikes during the morning from the café and had brought in a few more bits and pieces.  She’d also been in touch with the Dog Family (as they shall henceforth be known) to update them and had managed to obtain the name of their pet insurers.  I would drop them a note later to ‘thank them for their assistance and concern’ and to acknowledge that I realised it was an accident.  The word had spread around our social group so there were a lot of get-well-soon messages to relay, and she’d had the offers of a series of evening meals.  As there wasn’t a lot she could do in the hospital, she and Dad left after an hour or two and were almost immediately replaced by John and Liz.  I was getting better at telling the story and the chocolate, fruit and biscuit stash was beginning to grow.

By late afternoon, the staff seemed happy that I hadn’t upped my morphine feed. Other indicators were normal and on this basis, they decided I didn’t need the drip anymore.  A decent meal, some evening viewing and that was it for the day.  Another disturbed night followed, although I was getting the hang of sleeping on my back, using the bottle and being polite to anyone who popped in to check on me just as I’d drifted off.

First thing on Monday I needed to call the team at work.  I got hold of Patrick and gave him the lowdown on my situation, listed a few actions that needed attention, and put in a request for someone to arrange for my laptop to be delivered.  After that, the time actually passed quite quickly.  I was trying to keep an eye on the cricket but another trip to a different type of scanner, an MRV, to check my veins for clots, interrupted my viewing.  Apparently many patients with fractures of the pelvis and acetabulum develop blood clots in the veins of the pelvis, thighs or lower legs.  If the clot travels through the body to the lungs it is called a pulmonary embolism and can interfere with the patient's breathing.  I got a visit from the ‘Wellbeing' advisor, another guy from the orthopaedic team, and a chap from the ward who had broken his leg badly but was now practicing lurching around on crutches and impatiently waiting for his discharge paperwork.  

One of the regular nursing assistants offered to help me have a go at getting into a wheel chair and I was definitely up for it: it’s tedious just lying or sitting up in bed and I was keen for a bit of exploration.  Lower the bed, align the chair, and sort of slide into it using the good leg and arm for a brief bit of support.  After a few deep breaths, I made it, only to discover that I wasn’t going anywhere without a push.  The chair wasn’t one designed for self-propulsion and I only had one functional arm, but the guy gave me a quick tour of the ward before wheeling me back into my room and parking me by the window where I could gaze down on the endless coming and goings.

When Sue arrived I was still there, so after a quick catch up on the news and a phone call to British Cycling to report the incident and find if there was any legal or insurance process to follow, we headed off for a spin.  We took the lift down and it felt almost normal having a coffee in Costa, but I was becoming increasingly uncomfortable and was happy to be helped back into the bed when we returned.  Just as Sue was thinking of leaving, in walked Patrick, along with my laptop.  He had brought good wishes from everyone at work including a huge ‘customised’ get well card that Olena and Dorota had produced, featuring a big picture of an ‘adorable’ black Labrador. We chatted about work related stuff and, as my evening meal arrived, I sent him on his way, armed with a load of notes, ideas, tips and instructions for the guys to try and cover over the next few days.

I was becoming immune to the night-time noises, but frustrated about waiting for the op,’ which had not yet been confirmed for the following day.  However, Sue’s shift with me was supplemented by a surprise visit from Chris Williams, who managed to find my room via an alternative route through the offices and staff rooms.

I don’t like pestering people, but before I turned the lights out for the night I asked the nurse to check if their patient status board still had me down for ‘the knife’ in the morning.  Apparently it was still on and she reminded me it would be no food or drink at breakfast and I’d get an early visit from the Consultant.  Relieved to hear it, I slept well. For some reason, I wasn’t worried about the actual surgery, despite its categorisation in the ‘serious’ bracket.  I knew I was going to be knocked out so I wouldn’t feel anything and could do nothing about it other than trust the surgeon and his team.  I just wanted to get on with it!

Op Day

There was an unexpected start to the day.  Bettina, the chatty black nurse from South Africa, greeted me and then, closing the door, told me I needed an enema to ensure I was completely empty before the op. Given that I hadn’t been able to go since the previous Saturday, I didn’t blame them for wanting to avoid any messy surprises at such a critical time!  I’d never had an enema before but, to be honest, there wasn’t much to it. Once you’re over the embarrassment of having some chemical squirted up your bum, there is then an approximate 15 minute window to get out of the bed and onto the commode (the loo was too low and I wouldn’t have been able to manage the various transfers in time).  Having tucked into hospital food for three days, I knew there was plenty to clear out!  There’s no way I could be a nurse!

Soon after that, I had a visit from Mez, the surgeon, to say ‘hello’ and run me through the procedure. He was upbeat for 8am in the morning and seemed to be looking forward to the challenge, although he wasn’t 100% sure they’d be able to do the arm at the same time; it would depend on how tricky the pelvis fix was when they actually got in there, and how well I was coping with the anaesthetic.

My next guest was the anaesthetist who had a whole load of questions about my health before administering an injection of an anti-coagulant. (Apparently, blood clotting can be a risk with this sort of operation.)  Then nothing happened for what seemed like ages, until eventually, someone must have pressed the 'go for launch’ button and we were off!  The porter, and an accompanying Bettina, steered me down to the operating theatre.

What a place! I was back in the sci-fi film again and mesmerised by the rows of hi-tech equipment, the flickering screens and the ranks of overhead lights. The centre piece of the room was obviously the table and, as I was parked up to one side, I had a moment to appreciate just how many people were involved.  There had to be at least eight figures in surgical gowns waiting in what seemed like eager anticipation.  Within a few minutes, two gowned shapes, the leading actors, entered.  I recognised the anaesthetist and, without preamble, he stuck a drip in the back of my hand and asked me to count to ten…..

Surgical Notes - bit technical so skip if you like.

Fractures of the acetabulum are usually not treated for 5 to 10 days following the injury. Because the patient experiences significant bleeding with this fracture, the orthopedic surgeon must wait for the patient's own clotting mechanisms to go into effect – usually within three to five days.

Fractures of the acetabulum are harder to treat because access to this bone is more difficult, and because of the acetabulum's proximity to the major blood vessels to the legs, the sciatic nerve (the major nerve that arises from the lower spine and provides sensation and movement to the leg and foot), the intestines, the ureter and the bladder. Unlike a hip fracture, which can be treated relatively easily, to repair an acetabular fracture, the orthopedic surgeon, must, in essence, fix the broken bones from the inside out.

Realignment of the bones is done by an open reduction, in which the orthopedic surgeon makes an incision to directly manipulate the bone. Once the bones are realigned, the surgeon uses internal fixation to hold the bone in proper position during healing. Metallic devices including wires, pins, screws, and plates are used.

The surgeon realigns or reduces the bones as precisely as possible to prevent the development of post-injury related problems, especially arthritis. The bones are rigidly fixed with plates and screws to prevent future displacement and allow for rehabilitation to begin as quickly as possible. Accurate fracture realignment promotes improved bone and cartilage healing which in turn improves long term results.

After an acetabular fracture, fragments of bone may be scattered within the body. If surgery is not used to fix this, these displaced fragments heal in poorly aligned locations. Consequently, the acetabular cartilage surfaces remain incongruous and post-traumatic arthritic changes occur in the acetabulum.

Without any recollection, or awareness of time passing, or even dreams, I came round in another room.  A nurse was telling me to take my time and said she would get a bowl if I felt sick. Luckily, I just felt light-headed.  She gave me what I assumed was encouraging news.

‘No major complications. The surgeons seem positive and we fixed your arm at the same time.'

My mouth and throat felt like they’ve been sandpapered, but I seemed otherwise fine. The nurse suggested I prop myself up and talked me through a few things.  I was wired up to a drip again, and the morphine feed was available. There was an additional tube feeding out from under the sheet and was informed they’d put a catheter in as my pelvic muscles had been pulled, pushed and sliced during the op’ and probably wouldn’t be much use at controlling things for or a week or so.

I noticed I’d got a proper plaster cast on my arm and, not sure what to expect, I peered under the sheet. ‘Flipping ‘eck!’  There was a dressing that seems to stretch from one hip to the other and I was shocked to see that I was now sporting a full Brazilian!  It hadn’t crossed my mind that I’d be shaved and, not only that, my nether regions had been covered in some sort of reddish anti-infection coating, rather like someone had painted me with a diluted water colour.  With my new haircut, the rouge treatment and a catheter, I wasn’t feeling my most manly and I tried not to squirm with embarrassment at the thought that a nurse must have had to deal with my bits whilst I was out of it!

It was not long before I was wheeled back to my room and had chance to phone Sue who said she’d be in later.  I realised it had been seven hours since leaving the room this morning - no wonder my stomach was rumbling but the nurse suggested I make do with a drink for the moment as she took me through the pain management options.  I wasn’t hurting particularly but clearly she knew full-well that it wouldn’t be long before the op’ medication wore off and the body would realise it had been carved open, pushed around and stitched up again.  She also introduced me to some new kit I needed to wear, and which I’d never even heard of: Intermittent Pneumatic Compression (IPC) devices, one for each leg. They’re rather like full wrap around cricket pads that slowly inflate, and then deflate, up and down each leg and were designed to stop me getting DVT.  They weren’t unpleasant but I suspected that I would get fed up with them before too long.

Consultant James Murray popped in to let me know they were pleased with how the operation had gone, despite it taking longer than expected.  They would confirm their opinion with a scan the following day, but were not anticipating any obstacles to stop the rehab team taking over.  He surprised me when he said that, on his visit the next day, he wanted to hear that I’d managed to stand up, albeit using just the left leg.  I think I must have been running on adrenaline by that evening because I wolfed down my tea without being sick and couldn’t stop chatting when Sue arrived.  She had had a long day waiting for news, and still faced an hour or two of phone calls on her return home, to update friends and family. 

On my own later, I finally let out a huge psychological sigh of relief.  I realised I had been working really hard mentally for the last four days, blocking negative thoughts from overwhelming me.  It had been a lot more than just putting on a brave face and being cheery with the staff.   Beneath the surface there had been an ongoing battle to avoid panic, negative frustrations and fears for the future.  The implications, the risks of the operation, and the uncertainty of the way ahead had all been battering away on the edge of my consciousness.  Now, I felt they could be acknowledged and dealt with.

I listened to Jo Whiley on the radio and drifted off to sleep with the IPCs steadily massaging my legs.   Tomorrow, the fight-back would begin.

Post Op

It started to hurt. There was a nasty stinging pain across my belly that wriggling around didn’t ease.  My arm was aching and the IPCs were itchy and sweaty.  I’d topped out on the morphine allowance without realising it and was now supplementing it with codeine.  The night shift nurse’s regular visits reassured me that this was normal and that the pain relief balance shouldn’t take long to get established.  By breakfast we had it under some sense of control and I was given a planned dosage for the day, and they agreed to let me remove the IPCs for a few minutes each hour.  I felt happier when, taking the opportunity of the wee-bag change, I was able to get out of the gown and get my boxers back on.

The arrival of the physio was earlier than I expected.  In fact it was two young women who declared their mission was to have me standing on the good left leg and into a chair within a few days. However, for today I just had to practise how to sit up properly, swing off the bed, stand on my good leg and manoeuvre into the chair. There were some leg exercises I could do in bed.

‘Try to lift your leg a few inches off the bed.'  It was easier said than done as I realised the muscles and nerves didn’t want to respond and I barely managed an inch.

I was surprised at how exhausted I felt so, following yet another excursion to the scanner, I called Sue to give her a day off from the ritual daily visit as all I wanted to do was doze off.  Kate, one of the physios, was sympathetic but insistent that we go through the exercise routine.  Although feeling weary I was glad to get the IPCs off and practise a new trick - trying to move my legs apart and back.

When Mez arrived later in the morning he explained that the body was channelling all its resources into repairing the trauma damage caused by the operation and the effects of the anaesthetic.  This meant it had no surplus energy and sleep was the best recovery mode for a day or two.  Apparently the scan had confirmed what he was hoping:  the operation seemed to have gone really well and he provided some details.

They’d followed the normal process for cases like mine - made a big opening in the abdomen, eased aside and clamped out of the way the various muscles, blood vessels and nerves, only cutting where necessary in order to gain access to the broken bones. The fracture fragments were cleansed and the fractures were realigned before the fracture sites were stabilised with screws and plates. He seemed particularly pleased with the gap he’d achieved in the hip between the acetabulum socket and the ball of the femur which, he said, would reduce the chance of future arthritis. One of the team had then fixed the arm.  They’d put in a standard plate and were happy there wouldn’t be any long term issues.

He explained that the pain from the fractures would now be replaced by the pain from the surgical wounds and I was not to skimp on the pain relief to ensure I got enough sleep. There was another thing I wasn’t expecting: apparently I was going to get a lot of strange aches, sensations and numb patches in the stomach and upper leg muscles due to the unavoidable damage to the nerves in the area.  This might be permanent or take several ‘years’ to disappear: the tingling or numbness in my hand would probably be gone in six months.

I found it difficult to express how grateful I was to him and his team.  I was so impressed with what these guys could do!  But he was rather nonchalant and my thanks seemed to almost embarrass him.

‘Just take it steady and work with the rehab team.  I’ll see you again in a few days.’

I could hardly stay awake during the rest of the day, occasionally tuning into Spotify or reading a few pages and I flicked off the lights almost immediately after the evening meal.  I might have been really tired but inside I was feeling super-positive.  The uncertainties and nagging worries I’d been keeping locked away could now start to be let out and dealt with.  There was a plan, there was a timescale and I knew I shouldn’t rush it but …….well, there’s nothing like a target.  The next ten days all seemed to blend together and develop something of a routine. Eat like a pig;  regular trips to the scanner or X-ray; the physios pushing a bit harder; catching up with work stuff; Sue and friends’ afternoon visits; phone chats with a few people; Spotify; Jo Whiley…Jack Reacher.

Rehab

We were making progress!

On the medical front, after a few days the catheter came out and I was back on the bottle.  The IPCs were removed and the morphine was stopped; it still hurt but a regular dose of codeine seemed to make it tolerable. I was religiously doing the exercises, plus a bit more, and was rewarded with my first shower when I successfully managed to transfer from bed to wheelchair to shower chair and back again.

Sue wheeled me around the lobby on most days and out into the fresh air.  On one occasion, there was a fire alarm.  She needed to move the car, which was on a time limit, so left me parked up near the main entrance.  Half an hour later, everyone had gone back inside and I was still there, on my own like Billy No Mates!  Just as I was beginning to get lonely and a bit chilly in my T-shirt and boxers she reappeared, having battled through the usual late afternoon parking challenge.  Friends popped in.  Stuart, Dad and Jack all made the trip over and Murray had been in touch from Adelaide.

In the background there were moves afoot to make some short-term adaptations to the house: they wouldn’t release me until the occupational therapist signed me off to say I was going to be safe at home.  With help from Sue B, who was part-timing at the Red Cross, Sue had managed to acquire a commode.  Mike and Chris were moving a single bed downstairs and in due course, there would be a visit from the community physio assessor to arrange a stair rail and sofa risers and check the front door access.

Luckily the factory was starting its annual two week shutdown so I could spend a bit less time directing and guiding remotely and could just deal with the ongoing emails in one session a day.  On the other hand, there was quite a bit of work to do with the British Cycling legal people:  making a statement, obtaining quotes and receipts for the damaged clothing, forwarding the details of the bike check at Specialized.  Apparently the dog’s lawyers had advised their clients to stop all contact with me, which probably made sense, but I fired off a short text telling them I’d survived the op with a decent prognosis and was happy to let the legal process and arguments take their course, whatever the outcome.  I didn’t get a reply which surprised me slightly because they seemed like a really genuine, concerned family, but maybe they were taking the insurance guidelines very literally.

A week after the op’ was the big day:  I got a chair with small wheels that enabled me to push and pull my way around the room.  I was slow and it was surprisingly hard work, but over the next few days the technique developed and they allowed me to do some solo trips around the ward and accompanied forays down into the lobby. The other big plus was that I could get to the shower and loo on my own!  It’s amazing what a psychological milestone this was and it meant no more bottles during the day.

Hospital discharge

Patients without other complications are discharged after they regain normal bowel and bladder functions, they are comfortable on oral analgesics and the physical therapist approves the patient's rehabilitation efforts.

The staff were happy enough to start a dialogue with Sue on a return home plan.  The lady responsible for the link between the hospital and the community support teams was on the case and we tentatively targeted Friday, only two days away. There was a range of boxes to be ticked: more x-rays to check I still looked good internally; a DVT scan; a physio sign-off; and agreement on the pain control medication amongst them. The one thing I was a little bothered about was that despite eating everything put in front of me for over a week since the op’, I had not managed a ‘number two’. The staff told me it was no surprise because the muscles in the area had been traumatised and codeine is notorious for causing constipation, but apparently there was no question of my leaving until I’d had a bowel movement.  By Friday morning, despite being on laxatives for 24 hours, I was no closer to success and the nurses were starting to tease me.

The ETD had also been pushed back a day, as Mez wanted to see me and he wasn’t available till later that day.  It wasn’t the end of the world.  I’d been surfing Spotify for nearly a fortnight - not just the usual back catalogue of my favourites - and stumbled across a few new names:  Lumineers, The Shires, Ward Thomas, the latest Capercaillie album.  I had the time to actually listen to the songs in a way I haven’t done since my teenage years when you’d know all the lyrics from repeated plays of your limited collection.

On Saturday though I was finally liberated and in an ambulance heading for home.  It had felt like touch and go at one point as nothing had happened for several hours since breakfast (apart from the inevitable enema which proved hugely successful) but eventually the paperwork was in order, my bag was packed and the drivers wheeled me off the ward.

It was almost impossible to express the gratitude I felt to everyone who had been involved over the last two weeks and I became slightly emotional saying ‘cheerio.'  From the surgical team who reassembled the fractures to the cheery catering ladies, they’d represented a lifeline. I’m pretty sure from observing the goings on for a fortnight that it could be run more efficiently and that less could be wasted, but I’m also 100% sure that the level of care and commitment couldn’t easily be beaten.

Recovery

Physical therapy

At first, isometric and gentle range of motion exercises are supervised by a physical therapist. After six weeks, hip motion and strengthening activities are increased. Weight-bearing restrictions relax as hip strength is achieved. Aquatic programs may be beneficial for some patients. More aggressive range of motion and strengthening exercises begin during the second six-week period. After fracture healing, a home exercise program is encouraged for life.

Risks

Not following the prescribed rehabilitation program can have catastrophic results such as fixation failure and others.

I was manhandled through our front door by the ambulance drivers and eased onto our now-raised sofa. I would have danced a jig if I could have but had to settle for the warm feeling of relief that I was home.  Now, with Sue’s support, I could regain some control over events: eating when and when we wanted, going outside when it suited and not being bothered all the time by checks of temperature, BP and the like.

The lounge was now my bedroom so I was confined to the downstairs for a few weeks and I needed practice to manoeuvre the wheeled chair between the rooms and get the angles right to avoid chipping the paintwork.

Sue had been invited to Andy and Nikki’s for dinner but, hearing I was home, they had adapted the logistics and brought the meal round to us.  It was brilliant to catch up and see them with Mike and Bridget and Dee and Andy.  Funnily enough all the couples that evening were dog owners, though I don’t recall making any real anti-canine comments.  It was an evening when, once again, I appreciated how lucky we were to have friends who could be relied on for their support

.

So the challenges for the next couple of weeks were taking shape:

•  meet the community physio team and agree the exercise programme.

•  confirm the follow up hospital check date and when they’d let me have a go with a              Zimmer frame and crutches.

•  figure out how to get up and down the front door steps.

•  not spill any of the wee bottles on the carpets.

•  obtain a wheelchair from the Red Cross.

•  introduce Sue to the delights of nursing: my left hand skill-set was improving, but she    still  had the pleasure of emptying the commode.

• figure out what level of care I might need when Sue went back to work in a few weeks’ time when term started.

It was actually quite a relaxed life for the next week or two. The programme was underway.  The ‘outdoor’ wheelchair had arrived.  I was working from home for a few hours each day and sleeping well. The community nurse had taken the stitches out and I was now the proud owner of a 20cm scar.  It still looked a bit inflamed but I felt it would add a James Bond dimension to my torso when it healed.  And now I was off the codeine and onto paracetamols as the pain steadily eased.

Following a return check-up trip to Southmead, I got to use a Zimmer! It was a customised version with forearm supports that looked a bit like tri-bars for a bike and hand grippers on the end to allow a degree of directional control.  I couldn’t wait to get going but it was not a particularly athletic transit out into the corridor.  Firstly I had to lean quite a way forward to be able to sit the arms in the rests whilst simultaneously ensuring that I was not putting any weight on the right leg.  To make any progress I needed to use the grippers to lift and lurch forwards with the frame and then do a catch up step with the left leg and drag the right after me.  Not elegant and I looked like a stooping old man, but it worked and hey, I was back in the land of the upright!

Wheelchair excursions were an eye-opener!  Firstly I was almost 100% dependent on the pusher/lifter and their ability to negotiate steps, curbs, uneven pavements, slopes, open doors or find a disabled loo!  Sue was more than up to the task but it wasn’t always quick, or without a degree of effort.  God knows how some people cope looking after a disabled person!  You quickly realise how little thought is given to disabled access.  Another curious observation I made was that I was now on the same eye-level as children and under the eye-level for adults!  When being pushed along the pavement, I’d find myself making eye contact with kids and nodding hello whilst their parent would be failing to acknowledge me, probably without even realising.  Some conversations with people or acquaintances we’d bump into would go on over my head and I had to learn to butt in a bit to join the conversation.  A tiny insight into life in a wheelchair.

Aftermath

We set ourselves a mini-target - could we get over to St David’s and join the gang for the Bank Holiday?  Clearly camping wasn’t going to work, but Di and Pete insisted we share their luxurious static van, so we decided to go for it!  We loaded up the wheelchair and Zimmer in lieu of bikes and boards. En route we called in on Abergavenny hospital to see Jackie who had just fallen off her horse and needed a hip replacement. It was great to see everyone and whilst I didn’t do much, apart from sit on the verandah soaking up the view, it was a welcome change for Sue who could now get out and about and relax a bit.

A week later we managed another small excursion which I’d have hated to cancel.  We took Dad to an outdoor orchestral performance at Chepstow  Racecourse to celebrate Battle of Britain Day. Bit of an epic getting from the carpark but it was a beautiful, cloudless early autumn evening, capped by an air display from a Hurricane and Spitfire.  A large number of the audience were elderly and it was clearly a hugely emotional moment for many as the planes rolled, climbed and dived overhead (more on this theme elsewhere - see Merlin chapter)

Progress continued.  Three weeks after getting home I was allowed to do ‘light-touch weight-bearing’ and took delivery of some adapted crutches.  This really gave me an opportunity for measuring progress.  There were some tricks and techniques to be learnt such as getting up and down steps, but after that it was more about speed and distance, something I could easily relate to.  I’d been back at work a week and whilst I was banned from the shop floor, I got plenty of practice in the office and going up and down to the canteen.

The upstairs at home was now accessible by negotiating the stairs on my bum and, one week later I’d figured out how to go up on crutches too: good news as it meant the commode was now redundant and the lounge could be restored to its normal function.   At last I also got the okay that I didn’t need to keep sleeping on my back.

After another six weeks, the plaster was off my arm and I was onto standard crutches and a medium weight bearing regime plus a load of exercises to bring the hand back to strength.

The Accident Diary records Sunday 26th October as a big day: the first time back in the car!  I drove to the pool and banged off a straight 1500m.  We followed it with a trip to Westonbirt Aboretum for a short walk in the autumn colours.  Psychologically I was back to where I needed to be shortly after the op. Now I could start to catch up physically as well. 

Happy chap.

Retrospect

I was lucky.

I had access to a good health system that can scoop you up and get you back on your feet. I’d had a choice of two hospitals for heaven’s sake, and didn’t even need to contemplate using my private healthcare. I had even ended up at the one with a world class specialist surgical team.  I’d also had a support network of family and friends to take care of all the other necessary tasks and help keep my chin up and an employer who needed me as much as I needed them.

I learnt a few things about myself.  I discovered that I get concerned rather than scared and annoyed rather than angry.  Interestingly, I seem to be able to block the negatives thoughts from gaining any dominance (or is that denial?) and I clearly need goals and targets rather than a general drift in the right direction.

One of the nurses told me they classify patients as either ‘Tiggers’ or ‘Eeyores’ when they arrive on the ward and they use this as a guide as to how long a patient might stay. I’d have felt a bit miffed if I’d found out they’d got me down as an Eeyore!

Nearly seven years on there’s virtually nothing physically I can trace back to the incident.  The tingling in my fingers disappeared after six months and the strange muscle numbness in my right quad or hip only reappears if I haven’t exercised or stretched for a few days.

I was really lucky.

Images removed : Black Labrador(Freepik) Ashton Court House (Epigram) Southmead Hospital  (Wikipedia)