Change of Life’s Goalposts

Anita arrived and what a mood change, as uncomfortable as I was but not in any real pain, it was so good to be out the other side seeing her, a heeling tonic in itself. I’d been moved to a general ward of four beds, old guy opposite came in for kidney scan found cancer on the spine, to my right another old guy had a fall and bleed on the brain and in bay 4 a guy in his late 40’s who had a wake board accident and broke his back and had been in six weeks already in a proper bad way and spent most of the time behind closed curtains, they made up the triple brass midnight nose snoring orchestra. Back to regular eats now albeit trial and error with swallowing stuff, so mainly mince stuff, mash, soup, pasta, veg that kind of thing, backed up with goodies that Anita brings in, you know me and my snacks. Lots of amazing messages and thank god for video calls all again great tonic and I realise now a massive relief for all those on the outside that things had all gone to plan. Change of life’s goalpost!

Was it time for Anita to go already the precious hour (well eaten into and over) but she had an hour + drive back home and normal life to carry on. Hospital life carries on seamlessly through shift changes but the standard never slips. Laying there mind now changing tact into all those things, movements, actions we all just take for granted when we are fit and able and the simplest of things just shifting in bed, to reaching for something on the table right there, yes right there!! becomes something to achieve. Being able to sit up and eat properly and drink a cuppa without a straw, make it to the toilet just 3 meters away seemed massive goals to try and achieve, the whole thought of getting on my feet as Nik had said this very morning seemed so very distant. Change of life’s goalpost!

The battle of the visiting hour meant Anita could not come over on the Sunday as the slot was given to my parents, so a video call was arranged with wifey instead. Mind you both parents came walking into the ward how they pulled that off heaven only knows but all the same it was good to see them both. Both looking well and, putting aside any issues they may have had, both in their 80s now I was expecting the lecture on “should you still be doing this sport at your age!” but it never came because it’s what we do, it’s part of our life and if you give up on things you love and love doing then what have you got? My mum potters around doing her thing looks great for it, my dad still enjoys riding his various motor cycles even after a RTA last year; yes it’s knocked his 60 years of experience but he’s back doing it ‘inspiration right there’. There is lots of inspiration about if you look – Brook Mcdonald’s story a year after breaking his back in a UCI world cup DH race, more pro riders that have had big crashes, but even on a local level riders I know have had some big knocks and long recoveries and are back on the bike. Change of life’s goalpost!

No Sunday lunch today but again thankful for my lunch think I went for the sandwich option with added snacks that Anita had smuggled in. Looked a nice day out as much as I could turn my head right to peer out of the curtains. Had a video chat with Anita, Tate, my sister and responded to mountains of messages and well wishes, even from people I don’t know, made my heart smile. Anita told me of another local guy that was at SJR who’d broke his back, punctured lung, broken ribs – James Fagan, bro of Sam Johnson exceptional rider and trail building guru. We exchanged some messages and shared experiences but I couldn’t get to see him, due to the Covid restrictions, perhaps a hook up when we are out, sounded awesome. The goal of standing up would come tomorrow partially aided, but right now with the loo 3mtrs away and having to walk there seemed insurmountable – enter more tears, not running into my ears this time as 30 degrees bed tilt meant cheeks run off. Seems silly I know but it’s those simple things that seem so very f-ing hard as you battle with your thoughts. Change of life’s goalpost!

First shit night’s sleep as the JR philharmonic brass nose orchestra kicked off early, at best it was an hour here, an hour there, interrupted also by vital checks and another regular injection in the abdomen wasn’t good prep for the next day’s getting on your feet party! Getting used to the shift changes now and collecting my empties (urine bottles) was I plugged into the mains water system? Breakfast down, wash n brush up, visit from the consultants and encouraging words from Katarzyna saying “I want to see you up today and we’ll book you in for some x-rays OK”. She was so so gutted she could not attend the actual surgery procedure in person, but again spoke with excitement on how well it went. Text book, neat and tidy, “trust yourself Mark, your neck is super strong but use those muscles OK”. I felt energized but scared at the same time as the nurses arrived to get me up. Roll to the right hand side of the bad with feet slightly dangling over the edge ready to go for the sitting up first stage. On three… one, two, three big push with my arms and I was sitting on the edge of the lowered bed feet on the floor, the sheer weight of my head and shoulders felt like I was lifting half dozen bags of cement head feeling so so wobbly “trust your neck it’s strong” on repeat in my subliminal thought, you got this. Nurses on hand just in case I was too unsteady. Gather myself some slow breaths and here we go something you would just take for granted, one big push and I was up on my left leg with my right knee still on the bed, that immediate rush wasn’t exhilaration as I was hoping it was the opposite end of the scale the weight of me and gravity bearing down on my neck, shoulders and back was unbearable to the point the pain threshold had been superseded and I thought I was going to faint. I couldn’t move, I was hyper ventilating, the nurses unsure what to do, trying to ask me if I was OK, I couldn’t get any rational words outs, my thoughts were “no I fu-ing wasn’t”. I just collapsed on the bed in a blubbering mess nothing positive there to hold onto, more drugs to calm me down and I hope to re-group. Change of life’s goalpost!

Took a few hours to get to some level playing field aided by the thought Anita was due in around 3pm. With my music and funky blue tooth ear buds I sank into my music, catching up with friends until Anita arrived. Told her about this morning’s set back trying to hold back the tears again, but with her encouragement we agreed to give it another go when I was ready. Felt daunting once more but with her there it relieved some of that anxiety, as I got to the right hand side of the bed once more. De-ja-vu, legs dangling onto the floor ready for the push to sitting position and go! I was sitting again so good so far. Sat there for bit to steady my head and perception of balance, ok ready with her holding my hands I went for the two footed method unlike the scared effort of the morning and I was up ! I was bloody standing up! Bit like Bambi but I was up as gravity perched that weight on my neck, shoulders and back, what’s with these fuc-ing tears albeit ones of happiness I think. It must have been 5 minutes before returning to sitting then slumping to my right pleased and absolutely shattered a goal achieved. Change of life’s goalpost!

I still had no idea of what the metal works looked like in my neck or the gory scar, couldn’t really feel my neck shoulders or back as it felt like a scaffold plank. Had quick look at my 7iDP lid and examined the damage OMG! Well that did the trick and possibly saved my life or at worst some sort of life long paralysis. I just don’t get why people think they are uncool I’d gladly swap ya! James opposite was discharged to his local hospital and the guy to the right of me also going home, still curtains drawn for the other poor guy and then there was two. Only for a short time as a new guy came walking in undressed and plonked on the bed opposite, brief with the nurses, me eves dropping “well I was just standing in the pub and then some bloke punched me out cold! It’s OK as my mates got him and I hope he’s in the morgue” hhhhhmmmmm twat I thought and wanted to punch him too just had that way about him !!! Change of life’s goalpost!

Tuesday x-ray day and a possible challenge of walking 3 meters to the loo to save Ernie’s urine collection round or have a shower. How exciting, how daunting! Just after lunch they came to take me down “do you think you could sit in a seat Mark?” “I’ll give it a try” I said so going over the same routine as the standing up, roll right side with dangling feet touching the floor and push and sit on bed edge, phew done. Take a bit of time to compose for the switch to the porters chair with a little help to switch I was in, phew! Felt like a full body work out but it was good to see the corridors in different perspective, more normal as we made it to x-ray ghost town. Finally we found radiologist who went over the procedure and that she needed me standing “do you think you can manage that Mark?”. Knowing that the more stable I would become on my feet the more chance I had of being discharged “I’ll give it a go” I exclaimed. There were supports to grab hold of but geez it was hard work getting up and I think exertion and gravity resulted in me pissing myself a bit! Fuck sake how embarrassing! Nurses not perturbed not a jot “don’t worry Mark you’re doing great hold that position”. I must have said sorry over and over again but again they just batted it off as if it was nothing out the ordinary… amazing people. Change of life’s goalpost!

Back on the ward I just crashed out but pleased I got the x-rays out the way another goal achieved, now I was looking forward to seeing wifey and the possible toilet walk. Bang on time she arrived like a ray of sunshine. Had a little catch up and she took a look at my scar and the x-ray I had taken a snap shot of. My nose was healing now as were the impact scuffs on my head from the helmet. They say once I’m stable on my feet there is no reason I can’t be discharged. Massive incentive right there grasped fully, told her about the disaster I had at the x-ray, but again it just didn’t seem to both her either, more important was getting up for the shower walk we agreed! A few sits on the side of the bed going over that routine a few times feet firmly planted on the cool floor thinking it’s 3 meters away I got this with one big push I was standing once more holding Anita’s hands gently just getting my balance killing the compression sock anti slip sock combo playing havoc with my OCD colour co-ordination! Change of life’s goalpost!

OK lets do this – fear, anxiety, drive, goals, discomfort, can I do this thoughts all jockeying for prime spot in my thoughts. Anita my safety net as that first step, second step, third step albeit a little doddery, 2 more meters, 1 more meter the door handle, smile, welling up, I’m there I fucking made it! I said felt like was a doddery old man to Anita she replied “well you are old, and you were doddery” we both just creased up with laughter or as much as I could laugh it felt good to laugh. Change of life’s goalpost!

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Simple fractures usually take about 6-8 weeks to heal, although larger or elderly bones take longer. There are four main steps to bone repair:

• The blood vessels ruptured in a broken bone cause a blood filled swelling called a haematoma at the site of the fracture
• A cartilage callus forms in place of the haematoma. It acts to splint the broken bone
• A bony callus forms, replacing the cartilage with a callus made of spongy bone
• The bony callus remodels in response to stress placed on it, forming a strong, permanent patch at the fracture site

Promoting the wound healing process is a primary responsibility for most health care practitioners. It can take 1-3 days for a closed wound to actually establish a seal. Infections usually occur in 3-6 days but may not appear for up to 30 days, according to the CDC guidelines for preventing surgical infections. The wound healing process can be seen as an overlapping healing continuum, which can be divided into four primary phases:

1. Hemostasis Phase
The hemostasis phase of the wound healing process begins at the moment of the initial injury, and takes approximately 15 minutes. Whether a surgical incision or accidental breakage of the skin, a wound starts an outflow of blood and lymphatic fluid. This starts the hemostasis phase of the wound healing process, which aims to stop the bleeding. During this process, platelets adhere to the damaged endothelium and discharge ADP (adenosine diphosphate) to create clumping in the thrombocytes, which stops up the wound. The enzyme thrombin initiates the creation of a fibrin mesh, which stabilizes the platelets into a stable clot. After the vasoconstriction is finished, the blood vessels dilate to allow an influx of other blood cells and thrombocytes.

2. Inflammatory Phase
The inflammatory response is the defensive phase of the wound healing process that lasts 4-6 days, and is often associated with swelling of tissues, reddening of the skin around the wound, heat, and pain. This stage of the wound healing process focuses on removing debris and destroying bacteria. Within 24-48 hours after the initial injury, white blood cells called neutrophils reach their peak population, and do their work of killing bacteria and taking away debris. As the neutrophils leave after about three days, specialized macrophages enter the wound site and continue the debris cleanup. Macrophages secrete proteins that orchestrate:

• The multiplication of endothelial cells
• Sprouting of new blood vessels
• Duplication of smooth muscle cells
• Macrophages also secrete growth factors like TGFs, cytokines, interleukin-1, tumor necrosis factor, and PDGF, which attract immune system cells and begin tissue repair.

3. Proliferative Phase
Now that the wound is clean, the proliferative phase (which lasts 4-24 days) begins the process of filling and covering the wound with new skin. This phase of the wound healing process has 3 stages that operate in an overall and ongoing process:

• Filling the wound
• Contracting the wound margin
• Growing new skin over the wound or re-epithelialization

First, red granulation tissues fill the wound bed with connective tissues and new blood vessels. Next, in contraction, the margins of the wound begin to pull to the center of the wound to close it up. Finally, epithelial cells come up from the wound bed and margins, and migrate until the whole wound is covered with new skin or epithelium.

4. Remodeling Phase
The remodeling (or maturation) phase of the wound healing process is where the wound bed slowly strengthens and gains flexibility. The collagen fibers reorganize, remodel, mature, and regain the tensile strength of up to 80% pre-injury. The collagen deposit in normal wound healing reaches a peak in the 3rd week, and maximal tensile strength is usually achieved by the 12th week. Depending on the severity and type of wound, the remodeling stage can last from 21 days to 2 years.

Primary Intention Wound Healing Process
Primary wound healing occurs when the tissue surfaces are closed by stitches, staples, skin glue, or steri-strips. A surgical incision that is closed by stitches is a good example. This sort of closure of the wound surfaces creates very little tissue loss, and makes the wound healing process as quick and easy as possible.