In 2013, war reporter Ed Vulliamy suffered a serious leg trauma as a result of a post-traumatic stress. Hes ultimately strolling again but its a painful story
I tell strangers I fell, to avoid having to explain. But two-and-a-half year later, I still do not know quite why I smashed my leg to pieces, apart from the fact that I jumped off a wall 5m high, having had a partial blackout. Grey-out as Ive come to call them. And that this is how I came to severely damage myself, to learn about levels of ache I never imagined, and about the tribulations of people with disabilities in a world with mixed largely hostile feelings towards the handicapped. And above all about the astounding medical science fabricated by a Russian called Gavriil Ilizarov, whose barbaric-looking invention saved my leg, and saves countless others.
This is what happened.
I had returned on the evening of Sunday 9 June 2013 from a week-long, too-short vacation in Greece, my first real break in many years. People had advised against this, saying that, strung-out, I should either take a month, or none at all and keep going. Wed returned from the beach cafe that morning, via a British Airways flight delayed four hours, to the usual mail from debt collecting agencies and parking authorities. Next morning, that of the accident, the tube was again held up at crammed Edgware Road station, public address system blaring, crowds heaving. I was unable to take it, apparently.
When I left the office, I felt strange. I was gratifying a contact from a pressure group called Global Witness, but( I learned afterward) told my partner I was find Kenny Dalglish. Youre drunk! she told, Get a taxi. I wasnt and didnt. The towpath along the canal by Kings Cross was shut and a detour go through a housing estate. There I felt suddenly lost: all voice discontinued apart from a power drill laying foundations for ghastly condos where lovely Victorian warehouses once stood VAR-OOM! VAR-OOM! I panicked, my vision lost all colour everything turned monochrome apart from the green of a hedge at the end of the route. Then I determined a wall 5m high overlooking the towpath. If I can simply get down there, I supposed, Ill know where I am.
When I landed, my clean-broken fibula and tibia were sticking out of my left shin at me, jellied matter dripping on the tarmac. The brain is a strange thing: Hold on, it told, Ive got a call to make. I phoned 999 and located where I was. Next thing I knew, several hours later, I was on a stretcher heading for University College hospital.
I arrived round in the recovery ward sometime during the night, after what I afterward learned was five hours of surgery, to find a heavy steel structure around my leg, from the heel to simply below the knee, held in place by five metal rods and 13 wires running into or through the bones. This is a dream, isnt it? I asked the nurse, hopefully. No its not, he responded. Around dawn, the fresh face of a Dutch registrar are represented at the end of the bed to tell me Id suffered a limb-threatening trauma; the violate was complex, multiple the lot. Some hours later, the consultant surgeon arrived, having been called out at 11.30 pm and operated until past three in the morning, to introduce me to my Ilizarov spatial frame, or external fixator as it is properly known. His name was James Youngman, and he has been a major part of my life since, as has Comrade Ilizarov.
A second operation was needed at UCH, called a debridement, to clear out bits of gravel from inside my leg and secure the frame, after which I was transferred to the Royal Free for two more both of them plastic surgery: a skin flap that would transfer muscle from my thigh and transplant it into my shin in place of a now missing muscle there, and the other to connect the blood flow. There was almost nothing alive beneath the breakings in the leg, and the osteopathic surgery can only work if the plastics are in place.
For this, I was lucky to be in the care of Shadi Ghali and his expert team at Royal Free. Ghali works on an honourable principle, he told, of favor not to amputate on the basis of a Cat scan without if possible having a look inside. This he did with a third operation on Friday 14 June, establishing that a capillary less than 1mm broad remained alive. A weekend passed during which his team offered cold convenience that they hoped a further operation on Monday would be successful. So Im not out of the woods yet? I asked. No , not yet. It was a long weekend.
Monday arrived, and after eight hours of surgery, Ghali announced that he had completed the skin flap, taken out and plumbed in a thigh muscle and its arterial blood supply into the shin, from which there now protruded a sizable bump a muscle in a hole too small for it. It was like connecting a motorway to a back alley, he explained. For a week, nurses utilized a scanning mechanism was whether the capillary was taking it. The exam was every four hours, during which the radiography made a exhaling noise if things were working. A lovely Zimbabwean nurse determined it every time with her light touch: Ah, what a beautiful voice, shed say, like a baby breathing.
The ward became my life. I watched most other people on it come and go. I utilized the same pocket book Id had on the Greek island of Ikaria to keep notes in, so that the pages progressed from Apollo and Eupheme rearing the nine muses to the intricacies of skin grafting and a morphine uptake chart. A Polish human on the ward had had his thumbs taken off by a hedge trimmer; an unfortunate Turk next to me was so restless in his hallucinations and so demanding of the nurses all night, it was as hard to learn from what he suffered as it was to sleep.
Coming round from an anaesthetic is a very weird experience. Once, I watched the orderlies putting labels on each trolley to indicate the ward to which the patient was to return, and I chided the nurse: Here we are in the underworld, and how cruel of you to be assigning these dead people back to life to fight for this or that Mexican cartel( Id lately been working in Mexico ). He looked at me sympathetically, and shrugged. Ah, I insure! I told. This is not Hades at all, its an opera production, Orfeo and Eurydice , one of those trendy stagings by Jonathan Miller, set in a hospital, and youre Charon the boatman cast as a doctor! In short, after four general anaesthetics in as many days, one is insane.
I lay there for four weeks while the plastics mended, and learned painfully first to lower my framed leg on to the floor, then to take a few steps with a Zimmer frame. I was on a cocktail of both intravenously dripping and oral morphine, gabapentin, stuff to open the bowels( bedpans are an awkward way of life) and God knows what else. My head was in a weird place: all music scared me, I could not read a word; good news made me ecstatic, bad news was shattering. Sleep comes hard in a ward full of angst-ridden people, but theres camaraderie and always a distraction, a hollow laugh and gory narrative. Family, friends and colleagues visited and in that I was a lucky human. No internet for a month heaven.
The break in the leg had left a gap in my fibula and tibia which needed bridging as well as healing. The bones needed to be stretched across the gap, using the pins and wires attached to and through the surviving bone, while new tissue grew. Thus, a few days before discharge, the the efforts of the Ilizarov fixator began: to lengthen a leg that had lost 5cm of bone and encourage the growth of bone tissue. The stretching was to be undertaken by turning dials on the frame, arranged in three triangles nine stretches in all, by a millimetre a day. At one point, the special little spanner used for this was unavailable and the registrar called for a toolkit from the upkeep department. Its Meccano, basically, told an appalled friend of mine who was visiting.
The premise of Ilizarovs external fixator is basically that of the Inquisition rack and it worked well for the Inquisition. The pain management team used to ask me to rate the ache. I could only express it in terms of musical instruments: theres piccolo ache, which is shrill and pierce, usually from the plastic surgery. Then theres double-bass ache, deep in the bone when and after it is stretched, something on another level wholly. One to 10? asked an Australian pain management expert with peroxide hair and red plastic glass, simply back from ensure the Rolling Stones at Glastonbury. I dont know what to say, Id reply. Ive ensure people in Sarajevo with their legs blown off where do I fit into that? But nine, I suppose, fucking nine-and-a-half.
Eventually I was discharged with a large parcel of pills and greeted into the ground-floor flat steps were out of the question of good friends from my Granada Television days, John Blake and Karen Brown, down the road from Royal Free. The morning after my arrival, I stepped on to the terrace and breathed outdoors for the first time in weeks. My hosts were beyond kind and my partner, Victoria, heroic: schlepping nightly to Budgens after a long days work, cook, turning the Ilizarov dials and cleaning pin sites before resuming excruciating bedpan responsibility. The six-month regime began of clean and moisturising the skin flap, are concerned about the sobbing fluids.
There were twice-weekly checkups at both UCH and Royal Free, carried on and off ambulances by wonderful and outrageously underpaid paramedics. There were lovely visits from family and friends; even a hamper of delicacies from the office. I had to learn to weight bear, and it was agony, the frame pins tearing skin when I did so. But above all, there was the endless, nightly awfulness of bone-stretching this was the ache, but also the miracle; this was the social sciences to which surgeon James Youngman adhered.
James Youngman is the man to whom, simply put, I owe the continued possession of my left leg. Had he not operated for three and a half hours that night of 10 June, I would probably have a prosthetic shin and foot. Youngman would not say so himself, but all his patients knew when we lined up in the passageway of the cellar outpatients department at UCH on Tuesdays that we were ensure the best use of the best. UCH was his alma mater, after which he became a specialist in the Ilizarov frame and its American echo, the Taylor spatial fixator, at the Royal National Orthopaedic Hospital and the Royal London Hospital before taking up the consultancies here and at St John and St Elizabeth hospitals.
He is as passionate a sailor as he is a surgeon, and pioneering champion of the Ilizarov method of bone-healing that was for a long time considered barbaric in the west.
Born to illiterate mothers in the Caucasus in 1921, Gavriil Ilizarov advanced quickly through medical school and endeavoured to general practise in Siberia. Though he was untrained in surgery, he was the only physician for miles around and experimented with orthopaedic patients( and on puppies) and devised his revolutionary fixator technique in the 1950 s. He ran in relative oblivion, using the spokes and rim of a bicycle wheel to construct the fixators, but by 1968 his renown was sufficient that he was asked to treat the broken tibia of Olympic champion high jumper Valery Brumeland he became head of the All-Union Orthopaedic and Traumatic Centre in Kurgan. The technique traversed the iron curtain when Ilizarov treated the writer and explorer Claudio Mauri in Italy in 1981.
Youngman prudently preferred not to meet for our long-planned discussion of Ilizarovs science until my narrative had reached its happy objective, ergo when his work had been successful, which it was. We arranged lunch to this end just recently, and it was a pleasure to fulfill the surgeon out of school. We met at the Frontline Club, a place for war correspondents among others, to feed beneath a Yugoslav flag I had torn off a tank in eastern Croatia. He renounced wine he had surgery to perform later.
He explained Ilizarovs theory of tension stress, whereby stress, mechanically induced by the frame, could produce regeneration of bone and soft tissue. The frame is first fitted by drilling wires through and thicker pins into healthy bone. This immobilises the fracture site, allowing the patient eventually to bear weight and thereby create a flow of force-out from the healthy bone, and affords for what Youngman calls distraction osteogenesis literally, turning the dials to get the pins and wires to pull apart the bones on either side of the fracture, so as to lengthen the leg and regenerate the bone tissue, rather than compressing the bones, as had been the received wisdom before Ilizarovs discovery.
The stretching creates what Youngman calls neovascularisation, that is, it induces the formulation of new bone. The gradual distraction also widens the actual duration of the leg, inducing up for the gap lost by a complex multiple break in my lawsuit 5cm. Distraction can regenerate other tissues as well such as nerves or blood vessels; for this reason, it is essential to keep the leg either elevated, so as to ensure blood circulation, or loaded, ie weight-bearing, as much as possible. Easier told than done.
Part of the challenge is to align the bones as they dock again from across the void, something that was to prove a major problem in my lawsuit. Ilizarovs steel frame is cylindrical in order to give greater supporting and help the alignment, which Youngman micro-measures by drawing lines from the centre of the femoral head to the centre of the ankle mortice, across the x-rays or Cat scan. Another danger is infection caused by the metalwork involved as I was to learn. Where union of the bone is slow, Ilizarov recommended bone grafts from other parts of the body, and I had my share of that too.
In late July 2013, I left John and Karens flat for my own apartment, where I expended two weeks on the third floor. The trip-ups to Royal Free were weekly now, also weekly to UCH to watch for signs of what looked like cotton wool forming in the void. It was slow, and Youngman recommended that I buy, from America, a machine called Exogen, which transmits an electronic pulsing via gel to the bone, for 20 minutes each day.
We encountered a problem: the stretching shin was not properly aligned to my ankle and the lower dials needed turning not one but three millimetres a day to push both shin and ankle into position. All I remember from those days apart from watching people enjoying a heatwave in the street below was the ache to which I would wake at night, as the bone-stretching continued, which made me burst into tears like a child.
It turned out, though, that the programme I had been given by one of the registrars while Youngman was away had me turning dials in the wrong direction. This necessitated a fifth operation to gust the realignment back past its original faulty position and into the correct one. I elected to do this without anaesthetic, I forget why. There was Youngman, wearing a smiley face on his apron, wheeling me himself into theatre and readjusting the alignment while I writhed. It was amazing to watch him through the haze of ache: deft and exact but with the manner of a human possessed, eyes snapping between the ankle and screen above him, while I wailed and pleaded for another jab of morphine.
That night I declined the recovery ward and overnight stay and paid a cab driver called Jan to come up from Glastonbury and drive Victoria and me to the little home we have there. I sat across the back seat of his taxi, sipping liquid morphine, staring at the moon and trees along the A303, and exhaling real air after 10 summer weeks almost entirely indoors. It was liberating. Landmark moments followed: a first coffee out, by wheelchair; a first walk that is, Victoria heaving the rented wheelchair up a hill towards Glastonbury Tor; even a first picnic to catch the last swallows, with friends from Bridport.
We had to sell the flat in London to pay debts and moved into my mothers basement as winter describe in still bone-stretching, up to my eyeballs on morphine and tramadol, with the noise of relentless drilling coming through the wall from next door, so the neighbour could build his cellar extension. I would escape to the office, where it was a joy to rejoin colleagues, though I cut a bizarre figure: unshaven, with long and unkempt hair, leg trapped in the frame.
I expended thousands of pounds on taxis over the months, coming in most days, and somehow managed to write work was a lifesaver articles on the Kennedy family, Mexico, Colombia, Derrys year as city of culture, Hendrix, Berlioz and Berlusconi. And every week, back to UCH to look at x-rays, for bone growth, the cotton wool in the void which, told Youngman, was ominously inadequate.
For the bone graft that was now necessary, he needed to transfer me to his practise at the Hospital of St John and Elizabeth but this sixth operation would be done at the Wellington hospital around the corner. The operation went well: bone was taken from my hip for placement in the shin, and a growth powder installed. Youngman also removed the lower, ankle-level, segment of the frame which was a scant but welcome reduction of the daily ache and clean routine.
Soon afterwards the pin sites became infected and I was prescribed antibiotics. Two weeks later an x-ray showed Youngman that one of the wires through the bone had snapped and a refit would be required, and I was booked into St John and St Elizabeth for another operation.
The team at John& Lizzys are the only people who can attain you virtually look forward to hospital. They were a joy to be with: comforting, bossily upbeat, funny and competent; the government had names that need acknowledging: Siobahn and Angela from Dublin, Claire from north Mayo. Youngman carried out operation No 7 with the usual panache and success, and I left to recover, plunging into deep winter, the worst of my life.
I was obliged to lie for 55 minutes in each hour, leg elevated, which I did hallucinating from tramadol, watching rain fall on Somerset without discontinue. I immersed myself in rereading volume after volume by Samuel Beckett, A% 0mile Zola, Franz Kafka and Albert Camus. Death had claimed three precious friends within a few weeks either side of this seventh op, all my age, and I reflected accordingly, and as directed by the bleak sagacity of Molloy , LAssommoir , The Trial and La Peste .
Slowly, springtime arrived: the bone grew, x-ray by x-ray the cotton wool spread and solidified across the void of the violate. By April, Youngman was able to record very good evidence of bone union, and at the end of the month, it was time to take the frame off!
It is not often that one yearns for hospital, but back it was to the life-enhancing Irish nurses, Youngman in high spirits, and frame removal without anaesthetic and very painful indeed the pins turning from out of the bone with the surgically precise version of a power drill, the wires whipped back through the holes in the bone. This was freeing: the Meccano and pins replaced by an air cast boot. The following morning I gleefully donned a pair of jeans for the first time since the working day of the accident and boarded a plane to the very hotel room on the island of Ikaria we had left the morning before the fall to start again. Cabin pressure on Aegean airlines made the now empty pin-sites hemorrhage profusely, but what the hell.
Summer arrived, with it the World Cup, and another setback. Although happy with bone growth, Youngman observed that the repairing leg was not exactly straight-out. This would, he explained, entail a further operation to re-crack the bones and affix a metal plate to straighten them henceforth. Back to the St John and Lizzy for operation nine, followed by a further round of antibiotics. This was now a trial by ache and painkillers, trying to decide which was worse; I opted for the former and shunned the tramadol. The next problem was: haematoma liquid coming out of the surgical site, danger of infection and antibiotics refilled by a colleague of Youngmans whose notes record an extremely complex history with respect to his left tibia. Ill say!
But as this winter approached, Youngman was sufficiently pleased with my progress( his, actually) to volume me in for operation No 10 and remove the metal plate, which was causing some irritation. St John and Lizzy had almost started to feel like home, and a( last, I hope) visit to the operating theatre like going for an afternoon snack. Out arrived the plate; at the follow-up, Youngman pronounced the magic words: Thats it. I gave him a heartfelt hug and we booked the lunch to discuss comrade Ilizarov.
Throughout all this, I had lived through the curse and privilege of a kind of sojourn with the disabled, a glimpse of what life is like with limited mobility and in pain with every movement; difficulty in any endeavor at traveling, every attempt an effort either dependent on the goodwill or subject to the malice of others. It was a salutary lesson which has left me forever and profoundly empathetic towards those with disabilities and mobility problems, and one full of surprises.
There is an Ilizarov frame club of those who have been through all this, and its graduates approached me for long conversations, as I do now when I insure person struggling in one. Wearing one, street encounters change: scary men with scarier puppies become suddenly friendly, fascinated by and sympathetic towards trauma, wanting to share tales( albeit a bit disappointed by mine, since it involved neither fighting nor a motorbike crash ). Top of the helpful listing were big dames in Somerset: Hello my lovely, can I help you with your shopping? Bottom were students at Kings College, London, who barged me out of the route, off my crutches and nearly on to the floor as I hobbled towards a friends lecturing. Travelling brings out the best and the worst, and a league table emerges: on Lufthansa from Frankfurt: Why dont you come through to Business Class, sir youll be more comfy, while the British Airways crew from Naples to Gatwick switched me from the aisle to a seat into which I could not fit except in manifest ache( admittedly, there was an apology from the airlines customer service department ). Bus drivers in London will watch you struggle towards the bus stop, wait a few seconds, smiling, close the doors and drive off just as you arrive.
But, amazingly, Im strolling albeit in pain. It is something Ill never again take for awarded and was a matter of religion in Youngman and thereby his religion in the Ilizarov method, and mastery of it. A faith that was not misplaced.
Two things remained. One was a visit to an NHS psychologist to consider( leg now fixed ): why the jump? I had not, I confess, connected the grey-out above the canal to my professional career reporting from Bosnia, Iraq and other war zones. The Royal Free psychiatrist had “was talkin about a” a dissociative episode, and left it at that. But now I described the voice of the drill, the anxiety and loss of all voice apart from the VAR-OOM! VAR-OOM! Where had you heard that voice before? she asked. Never, I responded. Biggest drill I ever heard, boring foundations. Can you construct that voice again? she responded. VAR-OOM! VAR-OOM! I think you had heard that voice before, she suggested, referring to Sarajevo, Iraq. We agreed that we opted the old-fashioned word shell-shock to the more medically correct PTSD, which had compounded other levels and causes of stress and exhaustion to bring about the grey-out and a jump for cover.
The other matter outstanding was Youngmans final diagnosis of the ache I still feel, especially in cold and/ or damp climate: extensive post-traumatic arthritis. He explained the option of an ankle joint fusion which, he wrote, may be difficult to achieve with criterion technique and he may be better off using an external fixator. No route, I responded. I am happy with all you have done, sometimes deliriously so and will leave things as “they il be”, mobile and eternally grateful. I asked if the ache aimed at improving with period; itll start hurting less, responded Youngman, when you start get younger every day.
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