Saturday, 28 March 2009

A complete history of my left ankle

I looked down at my left ankle as I was sitting in the bath today; my much-abused, scarred and skinny left ankle. It is my Achilles Heel, figuratively, if not literally. All the miles that I have walked and the mountains I have climbed make my past feel like it is a different reality, as though it belonged to a different person.

For thirteen long years, an injury to my left ankle dominated my life. Just when I thought that it was finally healed, that the pain was gone forever, I would be launched back down into the abyss. This is the story of my life through that time. It is all from memory, without any external references to go by. Some of the timings, particularly of the earlier days, could be wrong, but are indicative of what happened. I may be guilty of unreliable narration, but no errors will be deliberate.

I first noticed the problem at school; at least, I think I did. The memories are so hazy, clouded not just by time, but also by pain. The primary school was right next door to my parent's house, the house in which they still live, in a quiet, nondescript village in southern Derbyshire. Off to one side of the playground there was a sand pit; it may have been there for the juniors to play in, but it was also used as a long-jump pit. I used to like jumping, which is odd, as I have never really learnt how to fall.

One day I jumped into the pit, and was rewarded with a sharp pain from my left ankle. It was a searing hot pain that just as soon subsided, to be replaced by a dull ache. I looked down, pulled my sock back, and was greeted with the sight of something strange above the knuckle of my left ankle. I touched it gently, pushed against it, and was rewarded with another sharp pain as something popped back into place. As far as I remember I didn't tell anyone, and just hobbled around for the rest of the day.

Fast-forward some time, perhaps days, probably months. I am sitting at the bottom of the stairs in our house, the house that my dad had built for us, holding my ankle out and flexing it, wanting someone to see the problem. It started to happen increasingly frequently; I would be walking along, then I would have a sharp bout of pain and the peroneal tendon would ride up over the knuckle. In response, I would just push it back over. With hindsight, I was probably doing lots of damage.

I think I was about eleven or twelve when this happened. I moved on to middle school, where my leg was put in a cast for two or three months. The idea was to immobilise the ankle in order to allow it to settle. It seemed like a vain hope at the time, and so it turned out. The cast was lightweight, made from fibreglass, and over the months my left leg whittled away to nothing, the muscle lost through disuse. At first I had to put a ruler down it to scratch any itches; later on, a pen could be squeezed down the gap. After a few months they replaced the cast with another fibreglass one. They cut off the old cast with a vicious-looking circular saw, and I was greeted with the sight of horrid layers of flaking dead skin on my leg. Then it was encased once more; out of sight, but certainly not out of mind.

I had these large, wooden crutches, the sort you see in films of injured soldiers during the Great War. The modern, metal ones were available, but for some reason I was given the unwieldy wooden ones. The strange thing is I actually quite liked them, and in future times I would ask for them specifically. I became very adept at moving speedily with them, the top of the crutches seemingly embedded under my arms. I was a speed demon on crutches.

Other things proved more difficult. I used to have baths to clean myself; dad would wrap a bin liner around the cast, and I would sit in the bath with my leg sticking out. I recall it as being an impossibly awkward position, and utterly humiliating.

Then, when I was thirteen, I moved onto Denstone College. This school, situated on the top of a remote Staffordshire hillside, took pride in excelling in anything outdoors; sports, CCF and Pioneers, all physical activity, and all things that I had terrible trouble in doing. This set the tone for the five years that I spent there. It was a good school, but the emphasis on sports rather than academic excellence did not suit me.

At one point my dad and I were asked to go into hospital. We were greeted by a doctor and a photographer. I took my shoes and socks off and lay down on the bed. What followed was hideous. I gritted my teeth against the pain as the doctor manipulated my ankle into various positions; he would hold it in each one as the photographer snapped away. Apparently the photos were taken for a medical journal; if so, I never saw the results.

The doctors gave me a list of things that I could not do; I could not roller-skate, ice-skate, run, ski, or do anything where I stood a chance of twisting my ankle and worsening the problem. The list seemed all too restrictive for a thirteen-year old boy. My elder sister used to go roller-skating at a rink in Derby. I would watch her, ruing the fact that I could not take part.

I remember certain events vividly; when I was fifteen I was sitting in the library at the school doing some work. I screwed a piece of paper into a ball, then walked over to the bin and dropped it in. That is all I remember. I woke up in the sanatorium, with the matronly school nurse clucking over me. There had been a female prefect in the library at the time, and she filled me in on what had happened; I swayed as I walked over to the bin, as if drunk. I managed to get back to my seat, but then keeled over, out cold. The pain had got too much.

That was enough. That happened on a Wednesday or Thursday; on the Monday (May Day bank holiday 1988) I went into Bretby Hospital, where a pleasant doctor called Doctor Newton reassured my parents to trust him; that everything would be fine.

How I curse his name now.

I was on a men's ward despite being only fifteen; I think everyone else there was at least twice my age. Mum and dad were naturally worried, but no-one ever asked the questions that should have been asked. We got told there were two alternatives; they could put a metal rod between bones in my leg and my foot, permanently immobilising the ankle; or they could operate to try and staple the tendon down. My parents understandably chose the latter.

On the Monday I was bathed by a nurse, who shaved my leg. Then, on the Tuesday, I went in for the operation. First they covered my leg in a bleak fluid - iodine, I think - then they gave me a tablet that made me go all woozy. I remember trying to be manly and brave despite being very, very frightened. I had scarcely been into a hospital before; had never broken a bone or had other injury. Everything was so new and strange. They helped me to dress into a robe, and then, as I lay prone with my pulse racing, I was given an injection. Someone asked me to count to ten; I had not been expecting this. I counted to ten, then, unbidden, continued. I think another injection was given, and only then did a welcoming smothering blanket of sleep come over me.

I awoke back in my bed; my overriding memory is of having an incredibly dry mouth. It was so dry that I could not even croak, and I lay motionless in bed for what felt like hours before a nurse approached and offered some water to my lips. It took me some time to come to after what had been my first operation; to my surprise, my leg was in another cast, plaster this time, and the cast was attached to a series of metal rods and pulleys. The pain only came on slowly, rising in waves as the effects of the anaesthetic subsided.

When Doctor Newton eventually came to visit, I got told that I now had metal in my ankle. Apparently they had lengthened the tendon; first they had cut a sliver lengthways out if it, then they had cut the remainder. After that, the had used the sliver to join the two halves, extending it. Finally, they had put an evil-looking staple over the lot. That was a much as we knew; we only learnt a little more when my dad sneaked a peak at my medical notes as my mum distracted the doctor. My dad's attempt at humour: "Well, so, you're worth something to me now. If you die I can scrap you." It was weak, but I could see the fear in his eyes.

I cannot recall how long I was in hospital for; possibly a week, possibly less. Mum and dad brought in reading material for me - books and magazines - and I spent a long time talking to the people who surrounded me. One of them was a man in his fifties who worked for the railway works in Derby. He had been cycling home one evening when he had fallen off his bike, shattering a leg in many places. His friendly voice filled in the long gaps between visits from my parents.

My leg remained in a cast for a while, then it came out. For an all-too-brief period, I was without pain. I could do things. Then my ankle and leg start hurting once more, and I think there was another operation, followed by a long period with my leg in a cast. It was the start of a pattern that would last for ten years; an operation followed by an all too brief period free of pain. I tried to make the most of those periods - I did my Duke of Edinburgh's Award Gold expedition (the expeditions at Denstone were very hard), and did lots more walking around the area from school. For these reasons, I know that my love of walking has always been with me.

When I was eighteen I went to Queen Mary and Westfield College in London, to study the obscure subject of geological engineering (a combination of geology and civil engineering). The studies were interesting, and it allowed me to look at large engineering projects - a love that is still in my life.

Unfortunately, the pain-free period was not to last. At about Easter time, we went on a geology field trip to the southwest. It was an interesting trip, even though geology was not my favourite subject. The lecturer was an emeritus professor, so old that he had been a Japanese prisoner of war. During one of the nights I ended up jumping on a bed and banging my ankle on the wooden side of the bed. The next day we had a long walk studying the geology of the Torquay area, and my ankle was pretty much agony for the rest of the day.

So started fifteen months of absolute agony. At least, that is the way I remember it. That is the funny thing about pain; it is hard to remember exactly what it was like. Perhaps it is a self-defence mechanism, but I would see a specialist after yet another setback, and he would ask "is it the same sort and intensity of pain that you had before?".

The honest answer is, I could never tell him. It was the same sort of pain, certainly, in the fact it would be in my ankle and leg; but the same intensity? How do you measure that? The mind draws a curtain over pain, dulling the memories with time, but always lets you remember that it had been there. The memories of the pain have permanently scarred me; the scars are invisible to everyone else, but are all too vivid in my own mind.

For months I saw a beautiful blonde physiotherapist, Andrea, who would try and teach me to walk properly again. She would work the muscles and tendons to try and relieve the pain, moving and massaging my ankle. In the meantime I was seeing a pleasant orthopaedic surgeon, who would give me a series of ever-increasing complex x-rays and scans, looking for somewhere that the metal within my ankle had fractured the bone. The strangest of these was a bone scan; a kind of inverse x-ray. In this they injected me with a radioactive dye, then waited as the dye got absorbed by the bone. This gave them a very good view of the structure of the bone within my leg. As I half expected, it did not show up any problems.

They gave me a strange electrical device to attach to my leg. Every ten or so seconds, it would send a pulse of electricity into the muscles in my lower leg, causing my entire leg and knee to jerk up uncontrollably. Occasionally I would attach it to my wrist; if I held my fingers out straight, the electricity would cause my fingers to jerk closed into a fist. I went to the cinema to see Basic Instinct with some friends; the jerking of my leg caused the seat in front to move backwards and forwards, causing the man sitting in it to give me curious looks, as if he was wondering exactly what I was doing to cause my leg to spasm in that manner.

One day, a friend of mine, a devout leftie, visited the physio with me. I was attending the London Independent Hospital in Stepney Green, an excellent private hospital. The friend did not approve of private hospitals, and certainly did not approve of me attending one. One day, I managed to persuade her to come with me to a physio session. She sat outside reading a book whilst Andrea manipulated my leg on a bed. Suddenly she warned me, 'I'm going to just try something', then pressed down on the ankle.

My entire body jumped off the bed, and I screamed as I passed out. My friend came running in, wondering what these awful people had done to me. I didn't blame Andrea, particularly given what happened soon afterwards.

Despite the pain, I used to go for seven-mile walks along the Regents Canal, from neat my flat in Mile End all the way to Paddington. That was the funny thing, the thing that no-one seemed to fully understand; short walks did not really seem to effect the intensity of the pain. There was a nearly continuous pain, a background low drone that I could ignore. However, this background discomfort was accompanied by occasional hideous, agonising sharp spikes of pain. The merest pressure of the duvet on my foot could cause a painful twinge, and whilst the painkillers could dull the background pain, they did nothing about these sharp spikes. So, occasionally, if I felt up to it, I would walk.

I really enjoyed these strolls. The Regents Canal is a schizophrenic beast; one minute it passes through a beautiful area, all modern, glass-fronted buildings and posh wine bars, the next it goes through an area of old industrial buildings, with rusting wharves and graffiti-laden canal side buildings. I loved every single inch of this green corridor through the centre of the capital. I think they helped to keep me sane, helped to focus on something other than the pain.

I had probably been seeing Andrea for these hour-long physio sessions for about nine months, the majority of the academic year. Eventually Andrea proclaimed that she thought the problem was neurological rather than orthopaedic, and invited me to go down to see a different surgeon.

She led me downstairs to a small consulting room to see a man. My first impression was that he was a jovial man, and he had a round face, round glasses and a healthy mane of wild, shock-white hair. He introduced himself as Professor Sidney Watkins - the professor bit impressed me, if nothing else. I sat down on the bed whilst he studied my notes, then he spent about five minutes asking me some fairly searching questions and manipulating my ankle this way and that. Only then did he say the magic words: "I think I know what's wrong."

I cannot tell you how good those words sounded to me; I had seen so many specialists who were routinely perplexed by the injury. Yet here was someone who, after only a cursory examination, thought he knew the problem. For some reason I instinctively trusted him; perhaps it was his air of authority, developed over many years of practice, or perhaps it was just desperation on my part. I wanted someone to know what was wrong with me.

His idea was that the problem with my ankle was nothing to do with the metal or the bone; nothing orthopaedic, but neurological. In particular, that the main nerve providing the left-hand side of my foot was damaged. What's more - and I cannot tell you how much I wanted to hear this - he knew what to do about it.

Fast forward some time, and I'm in hospital for what I think was my third operation. This time, the hospital was very different - the London Independent is a light, airy and friendly place, clean and tidy. What's more, the room was private. I remember watching the first ever episode of Peak Practice, with Kevin Whatley starring alongside my beloved Derbyshire scenery.

I cannot remember much about the operation or the aftermath; just that Prof Watkins appeared to be confident. When he opened up my ankle, he discovered that some stitching had been left in after the first operation all those years ago. This was right next to the nerve, and the rubbing of the stitching against the nerve was causing the pain. Then, when I had banged my ankle on the bed, the nerve had actually swollen to encompass the stitching. As the stitching was attached to the tendon, the merest movement of my ankle would pull the stitching through the nerve, causing the pain. He removed the stitching, and protected the nerve with some fatty tissue.

I left hospital on crutches, my bag slung over my shoulders. My flat was less than half a mile away, but it was a stupid sign of independence.

For a year I had been attending occasional lectures at the Institute of Civil Engineers in Westminster, listening to talks on what was going on in the wonderful world of civil engineering. One evening, I chatted to a man in his early thirties, a civil engineer with a large international firm. He had spent the last ten years doing nothing but designing concrete beams; he was the acknowledged expert in his company on the things. Because of this, because of his utter specialisation, he never got to do other, more varied work. This in turn meant that he could not get chartered status, a prerequisite of progressing in the career.

I wanted to do site work; to be going around digging tunnels and foundations, constructing things. Yet at the back of my mind I knew that there was a good chance that my ankle would never be good enough to allow me to do site work. That meant that I would be stuck in an office all day, designing beams or some other ridiculous specialism. That was not what I wanted from life.

Friends started getting me freelance computing work, and slowly I started to abandon my degree. I did not tell my parents at the time; instead, I made sure that I had a firm background behind me before telling them. Thankfully, although they were disappointed, they understood.

With hindsight, it was the right decision. For my ankle did go wrong again a few months later, and I was plunged back into a cycle of pain, sleepless nights and physio. Professor Watkins again tried to protect the nerve with a sheaf of fatty tissue. I was plunged back into hospital life, and my degree was further abandoned.

I'd like to think I did fairly well for myself in that period; I did some freelance and contracting work, earned a little money. I was going through a phase where I would not tell anyone what was really going on, as if the truth (none of it in any way scandalous) was a weapon that could be used against me. There were a bunch of people, friends, who I went out with, singing ourselves hoarse in the back of a car on a Friday night, yet I doubt any of them really knew me.

Slowly I started to realise there were gaps in my knowledge. I could program well enough - certainly well enough to earn a good income - but I was totally self-taught, and there were gaping holes in my knowledge. As I was missing Derbyshire, I said goodbye to London and went back up north, enrolling in an HND at Derby University.

I really enjoyed the course. I was a mature student and, what's more, one who knew an awful lot about the subject I was being taught. In particular, I knew more about programming than most of the lecturers who were meant to be teaching it. I'd like to think that I thrived.

Then, my ankle went again. This time, instead of going back to see Prof Watkins in London, we went to a private neurosurgeon in Burton. The surgeon studied me, then proclaimed that the problem was probably not in my ankle but my lower back. In some ways that made sense; I was getting shooting pains in my leg, but I'd never really had any bad back trouble. My dad really did not like this prognosis; he could not see the sense in having someone fiddling about with my back - with all the consequent dangers - when the previous operations had all been in my ankle. He immediately sent me down to London to see Prof Watkins.

It was good to see the Prof again - he was a jovial, pleasant man, and I trusted him, even though he had not yet managed to fix me. He had an unshakeable aura of authority around him, a confidence that I now knew came from being one of Britain's top neurosurgeons. He took a look at the notes from the doctor in Burton, proclaimed him an incompetent, and looked at sorting me out.

So it was another operation. Again the Prof. tried to wrap the nerve with fatty tissue. Then it was back to Derby, and this time I felt as though it may just, finally, be over. I don't know why; part of it was trust in the Prof, and part of it was the fact that I was older. But most was the fact that there were now other things in my life, things that meant I was no longer quite so afraid of the pain.

I left Uni, and got a job at Acorn Computers in Cambridge, working on various bits and pieces of software - a port of Macromedia Director, work on build systems and Network Computers. Looking back, I loved it.

The pain started again before the end of my first year at the company. I drove down to London to see the Prof, who actually apologised for having had to operate so many times to fix the problem. That was a measure of the man - he was famous, so much more important than me, yet he apologised, even when I didn't think such an action was necessary. What is more, he had only a handful of private clients left; he had mostly retired, aside from his work in motorsport. I felt honoured that I was one of them, that he had not left me behind. Perhaps he saw me as unfinished business.

He decided that there was no other option but to remove the nerve out of my foot. It was something he had been trying to avoid; an irreversible action that could lead to serious problems with my feet. Yet again I found myself in hospital, afraid, trying to be a man despite the fear.

I remember asking Prof Watkins if he thought I'd ever be able to walk the Pennine Way, and his reply "I can't see why not," was joy to my ears. People had been telling me for years that I could not do this, must not do that, in case I hurt my ankle and cause myself another bout of pain. Yet here was a wise, expert man, who was telling me otherwise.

Telling me to chase my dreams.

I had the operation, and the same, long, curving red line on my ankle was cut open again. They had given up trying to stitch the wound closed, and a series of about thirty metal staples kept the wound closed.

I was determined to walk. At the time I lived in Waterbeach, just north of Cambridge, My bedsit was about two hundred yards away from Bottisham Lock on the River Cam, a beautiful spot. On one gloriously warm Sunday aternoon, I set out to walk from my front door to the river without crutches. It took me about ten minutes to limp to the river, where I was greeted with the sun glinting down on the water - it is a beautiful, enlivening spot. Even now, over ten years later, after thousands of miles walked and countless spectacular locations, it still holds a place in my heart.

The hideous reality only hit me once I climbed the bank up to the lock- I would have to walk back. It took me about an hour, including a long rest on a bench near a level crossing. Tears were streaming down my face by the time that I finally made it back to my front door, a heady combination of agony, adrenalin and euphoria running through my system.

About three weeks after the operation I drove down to London, parked at South Woodford, got the tube to Mile End, and then walked to the hospital. All the time the staples resolutely held my ankle together, like a line of miniature military defences over a trench.

Prof Watkins seemed happy with the results; he showed me a little tube that contained the nerve he had removed. It was a few millimetres in diameter at one end, and at the other it was a messy blob about double the size. He'd had to cut it out from the surrounding tissue, as it had been unclear where the nerve ended and the scar tissue began.

Next he used a needle and another instrument to test how much feeling I had lost in my foot, and thankfully the damage was little. The nerves had been damaged for so long, that some had grown over the side of my foot, meaning that there were few areas without feeling. In that way at least, the operation had been a success.

He used a disposable plastic staple remover to take the staples out - it looked like the sort you get in any office. As he did the last few at the top of my ankle, about an inch of the wound reopened. I was given an injection of local anesethtic, and some medistrips were applied to hold that part of the wound together. I managed to get back to South Woodford, and somehow I drove back up the M11, despite feeling very woozy from the drugs. Thank God I had bought an automatic car.

And that was that. Within fifteen months I had completed the Pennine Way, and I haven't looked back since. I'm a very different person to the boy I was then; I am more confident, and the fear of further pain no longer lurks like a spectre over my shoulders.

I still get pain from my ankle occasionally; brief glimpses back into the past that cause me to go into a cold sweat. ┼×encan tells me that my leg occasionally spasms in the night, in the same way that it did in those awful, hideous days of '92 and '93. I sleep through it every time. Perhaps my ankle will go wrong again, and the pain restart. If so, then at least I have made the most of the last ten years.

The problem is that I've seen so many other people who have had much more serious medical problems than mine, yet they live through it. Was the pain really that bad, did I have to let it consume me so utterly? And was the fear of the pain, that feeling that I would never escape it's clutches, worth the anguish? More than anything else, I feel ashamed of my own weakness.

So that is the story. The boy and man who suffered all that pain is the same person who now walks thousands of miles for fun. People seem to think I walk because of the ankle; that is far from the truth. I did the Pennine Way to prove that I could walk; since then, I have done it because I love it.

Was I weak? Was I strong? Was I a drama queen? Was I stoic? I don't know, and in many ways I don't care. I'm glad it happened; I'm glad I suffered, I am who I am due to the troubles and pain. The pain shaped me, formed me into the man I am.

I can't imagine being anyone else.


rfwitch said...

Aaah! Evil Explorer just swallowed my long and impassioned comment! ^%@!!

rfwitch said...

That comment was the epitome of clear thinking and cogent prose. I have to summarize now:

It did happen. You didn't imagine it. I didn't know you then, but I know you now. You do so many little things that I notice: you never step down onto your bad ankle from a height if you can avoid it; you always sleep on the left side of the bed so your girlfriend doesn't brush up against it; when your left sock is at half-mast, it means it is aching again.

I remember you telling me about a headmaster who said he'd never had a sick day in his life, complaining about children skiving when they are off ill from school. To those sort of people I want to say this: you are an outlier. You are a statistical anomaly that time will probably fix. One day, you will be ill, or in pain. Until then, try to use what mental faculties you have and dredge up some empathy.

But there will always be such people. There will be people who say that if you're not missing a limb, how come you are parking in that disabled spot? There will be people who say that people with M.E. just need to buck up, take a multivitamin and get on with it. And there will be people when, as you struggle up the stairs on the underground on crutches, will say, "Do you *have* to use those things?", because you've delayed them for ten seconds...