Going Alone at Last

Equilibrio

Back to work – Friday December 9th

My wheelchair turns left. All the time and, unnervingly, when it approaches the landing where a steep flight of stairs leads down on the left….it veers to the left, as if possessed by some demonic power. A wheelchair is surprisingly hard work, though rather less so since I got them to pump up the tyres. The slightest slope is quite a struggle and I am sure I have built up some upper-body strength when I’ve struggled to drive the wheelchair up the gentle incline in the corridor without veering left into the wall (or down the stairs!) The other big factor is the condition of the ground surface. It’s one thing to be spinning along on the vinyl flooring of the clinic’s corridors and quite different to be negotiating across the rough tarmac of the car park downstairs if I go down in search of a coffee from the vending machine in the entrance hall. It’s another opportunity to appreciate the plight of tens of thousands of wheelchair users around the globe, and to realise just how they struggle to fit into a world that is designed around able-bodied people.

The doctor has finally given his approval for me to move around the clinic independently, with my crutches. They have decided I have done enough exercise work to re-establish a working relationship in the muscles of my lower body, and I no longer need to be confined to the wheelchair. This evening, for the first time, I shall walk down the corridor to the dining room with a large cushion slung around my neck on a cord. Well, – when you’re on crutches, you can’t carry anything; and even in a wheelchair you need some sort of tray or attachment if you want to be sure you won’t drop your phone or whatever. Everyone needs a big cushion to raise the height of the chairs because the hip angle sitting on a low chair is dangerously acute.  Similarly, if you drop something, it’s no good thinking about bobbing down to pick it up; you mustn’t put strain on that prosthetic joint or you run the risk that it might just pop out of the socket…. And that doesn’t bear thinking about. Maggy has sent me a “litter-picker” for picking things up: the sort of novel gift that is normally found only in one of those booklets inserted into the colour supplements that accompany the Sunday papers.

The experience of doing circuits on crutches around the corridors is strange and unsettling. If I think back to the days after the operation, when I struggled from my bed in Foligno hospital to get to the loo, the pain in the hip and thigh was excruciating. Such activity would have the staff here up in arms, and it  is unforgivable that they fail totally to coordinate the post-operative process and treatment between the orthopaedic department at Foligno and the rehabilitation clinic here. There should have been rigid instructions about not moving from my bed without assistance. As it was I was lurching between beds and hanging on to the door-frame of the en-suite, just to take some of the weight off my joints. I think the sheer size of the prosthetic they inserted meant the incision had to be long and deep. I believe now that they should have kept a closer eye on me and given me more guidance about what I could and couldn’t do. On the contrary, what actually happened is that I remember the physio nurses and my surgeon applauding my attempts at walking in Foligno…Here they would have locked me in my bed and read the riot act – which is what they did as soon as I arrived here and started unpacking my suitcase.

But now, four weeks on from the operation, there is no pain in the joint. There’s some painful bruising around my backside and lower back, and some muscular ache from the exercises, but no hurtful pain where it’s all been healing. What is unsettling and somewhat disconcerting is the reduction in coordination and balance – equilibrio – is the new word in my Italian vocabulary. I feel a bit dizzy and light-headed and there’s the marionette sensation I described in an earlier post, that some ­of the strings connecting some of the brain’s commands to the limbs just aren’t getting through. We were doing an exercise this afternoon, lying on the stomach on the work-bench with the legs bending at the knee and kicking up and down like a child learning to swim. I realised that my legs were going all over the place to left and right and I had to concentrate hard to make them stay on a straight axis and not flop around.

The result of all of this is that walking with crutches is hard work, not so much because of any aches or pains in the joints but because I have to focus on staying steady, keeping the feet pointing straight forwards, not wobbling and maintaining a steady pace. When I get it right it is hugely gratifying but when I falter, or sway, I feel incredibly stupid and incompetent. It is all a fascinating process.

Another milestone today was a flight of stairs. I learned to my amusement that the mnemonic my sister Maggy had learnt at her Birmingham hospital is the same in the Italian health service:- Up to heaven, down to hell. What this means is that when you climb up the stairs, you lead with your good (heavenly) leg, and when you descend the stairs you lead with your bad (hellish) leg. It was much easier than I thought it would be, proving once again – I think – that the emphasis here on intensive bench exercises prior to walking practice all pays off. I have been very lucky; but Lord knows I could murder a good meal and a large Scotch.

A visitor from Rome

Saturday December 10^th

My elder sister’s son, Aldo is visiting me from Rome today. In the past few years, his family has turned out to be very musical – I think as much to their own surprise as to the surprise of everyone else. Aldo and both of the children sing in choirs that travel all over giving performances and participating in events. Tonight the children are singing in an opera at Spoleto, an Umbrian hill-town not far from here and tomorrow Aldo’s choir is singing somewhere else in the region. He has planned his trip so that he will be here at lunchtime today before he goes on to meet up with the children and be in the audience to support them tonight.

I was 15 when Aldo was born, and what seemed like a huge age difference at the time has – of course – diminished to the colleague category in recent years. I am finding something of a similar realignment as my children grow up; My eldest – Samantha in Hong Kong – faces the big Four-Oh shortly after Christmas while at the other end of the spectrum Digby, having recently become a father himself, moves into the final decade of his 20’s tomorrow. I hope that I can emulate my father by stretching the active years ahead. When we had the restaurant in Lincoln, Dad, well into his 70s, would be up and down ladders at this time of year, checking and changing the fairy-lights on the Christmas trees and giant star that decorated the fascias of the building. He once said that he rather fancied the idea of falling off the precarious ladder that was leaning on the Steep Hill side of the property. What better way to go, he said, than making Christmas brighter. The bottom of that 3-stage extending ladder was chocked up with some odd bits of wood and there was never anybody working with him and holding the ladder. My heart flutters when I think about it, even now. This was, of course, before Health & Safety legislation started to bite, and I imagine that today I would be locked up for dangerous working practices, whether or not there was an accident. He was constantly tearing a fingernail or cracking the dry skin of his thumbs when he worked in the bitter East wind that chills the side of Lincoln Cathedral after blowing across Holland and the Lincolnshire Wolds, direct from the Russian Urals. But Dad was careful, or maybe just plain lucky; he never injured himself with anything an Elastoplast couldn’t patch up. He would climb down at midday, hang up his colourfully patched jacket, smarten up his pullover and smooth back his hair with the palms of his hands, then perch on a stool in the bar with a glass or two of whatever red wine was open.

I’ve had 2 years of limping, and it has often made me think back to the time (at my age, more or less) when Dad was on the waiting-list for his hip operation. I used to get very angry with the Health Service when I saw his lack of mobility – the way he scrambled up the stairs on all-fours in his terraced house in Lincoln, and the way he winced as he limped along with a walking-stick. I’m not sure that I was ever as handicapped as he was at that time and I am incredibly fortunate to be able to take advantage of the huge advances in prosthetic surgery in the past 30 years. Even after just 4 weeks I can see that I have more flexibility of movement than Dad ever had after his operation. I remember Dad having to put elastic laces in his shoes because tying them himself was out of the question. I have to take it gently but I can already put on socks and tie my laces. I walked around the block this morning and the sensation remains the same; I have no pain, but I need to concentrate on my balance and stability. A few more weeks and…who knows?

Another day of rest

Sunday December 11^th

I lose track of the days. I forget it’s Sunday till I realise the corridor is unusually quiet and breakfast (well, a hot drink and dry biscuits!) has not yet arrived. The room is stuffy, and when I open the window to let in some fresh air in, it is unseasonably warm, blowing up from the south, from across the Sahara, the wind they call Sirocco. As it’s Sunday there will be no sessions in the exercise room, just a constant flow of visitors wandering slowly along the corridor, peering into the rooms looking for lost relatives and reinforcing the sensation that I am in a zoo, on the wrong side of the bars. Today I shall walk the corridors like these inquisitive visitors, testing myself to be a little more stable than yesterday, trying to be less hesitant when I turn the corner, building a steady rhythm and reducing with every step the amount of weight I bear down on the crutches. I take an unsupported step across my room to reach my hairbrush, but the room sways and my hip wobbles and I quickly reach for something to hold on to. The rate of progress is deceptive; one moment everything is solid and secure, then one slight falter and panic sweeps in and I am back to square one, rebuilding confidence like a house of cards that has collapsed at one glancing touch. I forget that it’s a slow process, but then I look at myself in the mirror and see this long, straight scar perfectly healed and I remind myself that it’s all going to plan, it won’t be rushed, I need that elusive quality… patience.

Counting my blessings

Lisa put her head round the door and gestured the universal sign language for coffee. I followed her to the lift and went down to the ground floor where we sat by the entrance area enjoying the mild late-autumn weather. I cannot imagine facing the sort of prospect that lies ahead for her, of knowing that the next 12 months will be spent in hospital with no certainty of just what kind of life lies beyond. At times like this one really does count blessings, and she was talking about the gift she enjoys of having suffered no kind of brain injury. Car crashes, as we know from family experience, can lead to extended periods of recuperation over months and years before the brain is fully recovered. Lisa, however, is very positive and appears to have lost none of her journalistic acumen and clear thinking. When I look at my own progress, especially in the past week, I find myself wondering what I have done to deserve such rapid development when others simply have no idea of their own prognosis.

I remember being in the private hospital a few years back, with all that incongruous ambiance of a ‘BUPA Hotel.’ It was a totally sanitised environment in a way that this clinic never is. We patients in Trevi are a mix of people adjusting to new knee joints or prosthetic hips on the one hand and people undergoing long-term treatment for serious disabilities on the other. While the ‘BUPA Hotel’ feels almost totally removed from healthcare and borders on cosmetic treatments, this clinic works across a wide range of abilities and disabilities. It’s an environment that constantly reminds me to count my blessings.