Wed 14 April, 2004
Today was a bad day by any standards. It began badly with a nauseous feeling at 6 am, and went downhill as I vomited a pile of bile a few minutes later. Fortunately that was into a basin provided for the purpose. The new sister (a man, as it happens) immediately put me on ‘nil by mouth’ to prevent further vomiting, so I was not allowed to eat or drink anything.
However, there was no written record to say I was on nil by mouth, and the sister later claimed that he might not have actually ordered that regime. I know that he did and I know he was covering up for a mistake.
Still, the morning went on with me feeling hungry and ill. In the late morning I was called down to radiography for an ultrasound scan of my abdomen. After a lot of waiting around I was shown into the treatment room where the doctor started scanning for more internal injuries. She said there was no serious damage to any of the organs such as kidneys, but there was a lot of internal bruising around the bones, where muscles and tendons had been attached and then stretched or torn in the impact.
The only other thing she mentioned was that I was constipated. I already knew that, and ascribed it to the dimethyl codeine painkillers, for which constipation is a known side effect. She then called in the senior consultant and I swear they spent five minutes discussing how badly I was constipated. ‘Impacted?’ she asked, moving the ultrasound probe swiftly over my lower abdomen. In the end they decided to leave my bowels alone and send me back upstairs, just in time to see my fellow ward inmates eating lunch.
Having had the examination, and ‘passed’, I asked one of the nurses if I could now eat something, as I was feeling hungry. There was no response. It was not only hunger, however. The dreadful stomach pains I had experienced over the last year or so had returned.
My wife came in, as she had every day, at around 3 and we asked again if I could have some food. Again, no response. Eventually, she got cross and complained to the senior nurse. Then a lot of things began to happen. First, the male nurse denied that he had ordered the nil-by mouth regime. Second, the nurses sent down for a sandwich, third, Iza went to the shop to buy a sandwich and fourth, the ward sister came along for a chat.
She was great. We talked a lot about things, and she prescribed some Gaviscon to help with the stomach pains; she also prescribed stronger painkillers for me to request if it all got too much. She also arranged an endoscopy for the next day, to check for ulcers and other damage to my stomach.
My wife returned with a sandwich. I started eating it but stopped before getting half way through it, and then felt nauseous. It all came back up within ten minutes. After that I knew I just had to ease my stomach in gently, so drank some tea with a bit of sugar and no milk, and then ate a couple of spoons of plain boiled rice for the evening meal. Fortunately, that all stayed down.
After getting to sleep I was woken at 11:30 by a doctor I had not met before. He told me that they had been examining my X-rays from A & E and discovered some large cracks in my pelvis. He said the likely outcome was to operate, putting steel plates and screws into my pelvis to correct the fracture and allow it to heal. Likely timescale: six months before partial recovery.
He was shocked to find that I had spent the last three or four days walking around the ward, albeit with a sick and Zimmer frame. This was definitely not a good idea, with a broken pelvis. It is likely to have exacerbated the damage. Damn!
I returned to sleep, feeling pretty awful.
Was it really a blackout?
The process of writing down all the experiences is steadily convincing me that I must have blacked out on the bike, prior to the crash. The doctors, however, are unwilling to agree with me. On the positive side, their view is that there is no medical evidence to support the contention. They are correct, of course. I have no history of such blackouts, there is no significant history in my family. A series of relatively primitive medical checks confirmed that I was fully conscious at the time of the checks. In addition, it is well-known that peoples’ memories play up in the seconds before and after such a serious accident. Jasstrong tells me that the brain needs 10 seconds or so to convert a sensory impression into a memory – something like a MP3 memory buffer. The impressions of such traumatic incidents are too much for the system, so the brain fails to convert those impressions into memories. Hence the very common trauma-induced amnesia.
Thus, the only evidence supporting the proposition that I may have blacked out is based on my own memory of events. And that is known to be unreliable.
To their credit, their detached position absolves them from any responsibility to inform the UK driving licence authorities (DVLA) of a potentially dangerous driver on the road. If they were to declare that I had blacked out, then they would have a legal duty to inform the DVLA that this individual is not safe on the roads, and hence, it is likely that I would be banned from driving. At the very least I would have to jump through a lot of hoops before getting a licence.
The doctors, then, have absolved themselves from that responsibility. And in fairness, I see very little way anyone could make a definitive judgement as to whether I did in fact black out or not, let alone establish a reason for it.
Nevertheless, I remain convinced that I did lose consciousness for a few seconds prior to the impact. First, why would any driver continue into the back of a stationary vehicle if he were aware it were there, and able to take avoiding action. Although I have not seen them, I understand that the witness statements show that there was no avoiding action. They report a motorcyclist ploughing into the back of the vehicle, with no brake lights, and no attempts to steer. I know my brake light was working because I changed and checked the bulb just a few days earlier, after a fellow rider had alerted me to the fact that it had not been working.
Another factor in my conviction is the subliminal vision I had, before waking up on my back in the road. I saw the rear end of a car, very close up, and had no time to even frame a single thought, such as ‘Oh shit’ or ‘this is going to hurt’ I remember thinking this extraordinary, as soon as I recalled the vision.
In retrospect, I now believe that the vision appeared after my front wheel struck the rear bumper of the car. I woke up in response to the impact, glimpsed the car in close proximity and then fell out of consciousness again as my head hit the car roof. A swift calculation of the distances and times means that after my wheel hit the bumper, my head would have taken some 70 ms to travel the 1m or so between the riding position and the car’s roof. That leaves maybe 20 ms in which to see the vision. That is one single TV half-frame, or half a movie frame. A very short interval, and consistent with the subliminal vision and lack of time to frame any conscious thoughts.
So, I am left with the personal conviction that I must have blacked out, but no supporting medical evidence.
To drive, or not to drive
My initial reaction, before my thoughts on the blackout occurred, was that I was happy to continue riding the bike. Nevertheless, in view of the near-death result, I was intending to offer my wife the power of veto. She went though a lot on the night of the accident, and it would not be fair for me to unilaterally risk that again, regardless of my own feelings on the issue. She, on the other hand, was very reluctant to force me into a decision against my will.
Having convinced myself of the blackout scenario, I now think I will never ride a motorbike again. Bikes and blackouts simply do not go together. Unless I can find a convincing argument to show I did not blackout, then I do not believe it is safe ever to put myself in control of a motorbike again. I was lucky once; I cannot expect to be so lucky again in the future. Needless to say, my wife is very happy with that decision.
The bike was a choice. I had the choice between commuting by bike or by tube. Five years ago, when I first got on the bike, I decided that I would never commute by tube again. Given the changed circumstances, I can adopt a different attitude to tube delays and over-crowding. In the larger scheme of things these are not, after all, very important.
Driving a car is a different issue. First, the doctors are right. There is no evidence whatsoever to show that I lost consciousness. Second, even if I did black out, there is no evidence to suggest it might be a recurring phenomenon. Third, it has to be said that low speed car crashes are much more survivable—for the occupants, at least--than low speed bike crashes.
So I have managed to convince myself that maybe I can continue to drive a car. On a bike it was mostly about myself and the risk to my own life. In a car, there are passengers—my children. Also, there are pedestrians and other road users. Imagine if I blacked out and killed a small child walking across a designated crossing point. It's not an easy decision.
I went to see my GP, and his reaction was very similar to the other doctors. He argued that there is nothing to prevent me from driving a car. However, recognising my need for more input, he proposed visiting a private clinic (for which I would have to pay) to see a consultant neuro-psychologist. There is such a clinic within a few miles of my home, close to Richmond Park. It is called The Priory, and has a reputation for being a drying out centre for celebrities. Apparently they throw a party for local GPs each year, with good food and good wine, in the hope of getting referrals like this one.
I am unconvinced about this. I very much need to get as much information as possible, but the more I think about it, the more I convince myself that no-one can possibly give me the reassurance I want. So either I accept the best medical advice, and gaily proclaim that it was just a stupid accident and I cannot remember the lead-up to it because of the stress-induced amnesia. Or I trust my instincts and avoid driving wherever possible. If the former, then probably I should get back on that bike, though frankly, I think that would be just stupid.
One year on
It took another week before they let me out. Not much to report. Things got better. More x-rays; more chats with the nurses and a bit of frustration over finally getting released.
I sold the bike, but I'm still driving a car. I had a couple of months to recover while the pelvis healed. I was lucky that the fracture was untranslated. That means the two sides of the crack had not moved relative to each other. All it needed was rest for a couple of months for the bones to heal. An x-ray 10 weeks after the crash showed no sign whatsoever of the break. The doctors tell me that there may have been a small amount of movement, and it's quite likely I'll need a hip replacement at some stage in the future.
The bike eventually came back from the repair shop on the day I returned to full-time work. I went out for a couple of rides. I still love the feeling of riding the bike, but it just seemed to make more sense to sell it.
The Barrett's oesophagus is still there. I take 30 mg of Lansoprazole, a proton pump inhibitor , and have an endoscopy once a year to look for changes.
The commute is not so bad. We used the two-month hiatus in working life to look for and buy a new house. The new house is closer to some good schools for the children, and a more convenient commute, by overground train. Much less stressful.