Dislocated ramblings of a fractured mind
Saturday June 24th
Five weeks ago today, I slipped on some gravel on a path in north Iceland and fell, breaking my right leg in three places and displacing my tibia and fibula. Since then, I have had three operations as surgeons in two countries have attempted to put the bones back where they belong and fix them there. I have three large surgical wounds. For the past ten days, since the third procedure, I have been mostly lying with my leg in plaster and elevated as instructed by the surgeon. After the most recent surgery, the surgeon told me of his concerns about tissue viability and wound healing, as he had found and debrided some necrotic tissue in the previous scar so I want to do all I can to promote healing, and elevation is important. If I put my foot down my toes still turn purple.
I watch other people walking in awe and amazement. After five weeks, I cannot imagine ever having the confidence to put one foot in front of the other and actually walk. I have even stopped walking in my dreams. I shunt around the house to get to the toilet in an old wheelchair and occasionally hop using a walking frame, but even that is hard due to an unrelated but chronic problem with the tibialis posterior tendon in my “good” foot. I can feel my muscles getting weaker by the day. I have a superficial thrombophlebitis in my right hand and wrist from an over-used infusion site that seems to hurt more each day and a row of bruises around my abdomen bears testimony to the twice daily injections of heparin I give myself to reduce the risk of venous thromboembolism.
I can’t go upstairs so I haven’t had a shower in weeks, I wash at the kitchen sink. Our living room has been taken over by a single bed brought down from a spare bedroom and our son built a ramp to enable my husband to negotiate getting me in and out in the wheelchair for hospital appointments.
My world has contracted immeasurably. For the past seven years I have worked on various projects training doctors and midwives in low-income countries, mostly in Africa. I should have been training midwife mentors in Togo these past two weeks, but since the most recent surgery I haven’t left my house, and won’t until my next appointment in four days-time.
I am simultaneously longing for and dreading that appointment. I am petrified that I will be told, as I was three weeks ago, that all the surgery has not worked and my foot bones are again misaligned, or that my wounds are necrotic, or both. I don’t feel that I could face further surgery. I don’t think my leg could face it either. Groundhog-day was devastating enough the last time around and I really don’t want to be there again but every little pang in my ankle induces that logic-defying fear.
Even if all is well, and I am struggling to believe it will be, there is a long road ahead both physically and mentally. I can best be described as “fearful”.
Sunday June 25th
Another night done. Not that I want to wish my life away, I am a great believer in seizing the day, but mornings are always better and feel more optimistic. I managed about 4 hours sleep last night without a sleeping pill. Sleeping with an elevated leg is very difficult because everything else is just not right. Aching shoulders are perhaps the worst thing, and turning from one side to the other is a major procedure, so the nights are long. Constant tiredness is demotivating and I end up wasting vast amounts of time scanning social media rather than using my brain more constructively. On that subject, being under a general anaesthetic for 4-5 hours doesn’t half mess with your head, and it takes days to leave behind the consequent brain mush. This weekend is comparatively better than last when I was beset by excruciating post-operative constipation, exacerbated no doubt by opiate-containing analgesia.
Despite all this, I am immeasurably fortunate. Even as my entitled-self moans about my lack of shower access, I reflect that around 1.9 billion people in the world do not have access to any water supply in their own homes. I have seen first-hand how even small children have to carry heavy jerrycans of water over considerable distances and am ashamed that I can think to complain that my shower is out of bounds when I can turn on the tap in my kitchen and access a supply of clean and even warm water.
Unlike many people in the world, I have been able to access high-quality health care provided completely without charge at the point of need. I have escaped the worry of having to sell any of my assets simply to cover the costs of my care or become saddled with catastrophic debt. Around the world, almost one billion people have to spend more than 10% of their income on health care annually, and the poorest are disproportionately affected.
A study in the Lancet published in 2015 estimated that 4.8 billion people, more than half of the world’s population, do not have access to surgical care. Again, the poorest people in low-income countries are disproportionately affected, whereas I was taken to safe, clean operating theatres staffed by expert surgeons without delay.
I am counting my blessings. I live in a country that has a health system that is funded out of taxation and able to meet my needs, and a comfortable home with running water. Sadly, the reality for too many people in the world in my position is so very different.