Life-changing injuries
Hospital and medical treatment for an injury
People we interviewed were treated in hospital for a variety of problems with different levels of severity; back, neck and spinal cord injury, head and brain injury, broken or crushed bones, punctured lungs, blood loss, burns, eye damage and hearing loss. The length of time spent in hospital ranged from just a few days to several months or, in some cases, over a year. Different hospitals offering specialist services could be involved. Some people, injured abroad, were flown home once their condition was stable and admitted to hospitals in the UK for further treatment. Mostly people were admitted to hospital from the scene of their injury and Marina is convinced the proximity of trauma centres in London, with neurosurgeons on site, saved her son’s life. One man said his spinal injury occurred during an operation.
To understand the extent of the damage caused, people had various tests, including MRI and CT scans, x-rays and nerve conduction tests.
Ed couldn’t remember his accident, so he was sent for tests to see if he had any health issues...
Ed couldn’t remember his accident, so he was sent for tests to see if he had any health issues...
SHOW TEXT VERSION
PRINT TRANSCRIPT
The consultant, the consultant neurologist that I’m under at the moment, is actually the second consultant neurologist. We decided going to this chap, simply because he’s an expert in trauma type injuries as opposed to the other guy who was more of a general neurologist.
Through him, he was very keen to find out if there was some sort of heart issue that caused me to come off the bicycle. Because it was quite clear that I wasn’t actually hit, but something made me come off. So I went and had quite extensive cardiology tests, and generally the heart was fine, even I’m sort of nudging up towards high blood pressure. So I’ve been advised to shift some weight and actually since the beginning of this year, I’ve come down from some 128 kilos and this morning I was 115. The target is 100, and we’ll see how we get on. But it’s, it’s working well.
Initially, some family members were warned that their relative might die or may remain in a vegetative state (where they are fully awake but have no awareness of their surroundings).
Marina begged the consultant not to give up on her son (Daniel).
Marina begged the consultant not to give up on her son (Daniel).
SHOW TEXT VERSION
PRINT TRANSCRIPT
I did ask him, “Had he seen injuries as bad as Daniel’s before?” And he said he had. He said, “But I’ve also seen MRI scans where there have been very bad injuries and the patient hasn’t made a great recovery.” So to me then that sounded as though there might be hope. But when he’d finished talking, I didn’t really have any questions. By this stage, you know, we were crying quite a bit. As he was leaving I said, “Please don’t give up on Daniel, that’s all I ask of you. Just try, try, try and do all you can.” And he did say that he would do all he could, but he would have to see what would be in Daniel’s best interests and I thought, ooh! You know, he was straight talking with us, as gentle as he could be, but the enormity of it was, was quite horrific and he left us then, it was 3 o’clock on the Friday afternoon and Daniel took quite a turn for the worst and at 7 o’clock the nurses came out to say that only Mum and Dad could visit Daniel as he was extraordinarily poorly.
When Marina’s son opened his eyes everyone was overjoyed, but it took time for him to become aware.
When Marina’s son opened his eyes everyone was overjoyed, but it took time for him to become aware.
SHOW TEXT VERSION
PRINT TRANSCRIPT
So, that was all fine and then three weeks Daniel was still in the coma, and another consultant came to see us who spoke along the lines that when they’d, when Daniel had been brought into [hospital], he was already in his own very deep coma and they had sedated him further, but in their opinion they didn’t think that Daniel would waken from his own deep coma. So they were preparing us for the fact when sedation was off, he might still not come round. And they were then thinking long term that he could be in hospital for six months and then require specialist rehabilitation and they thought they would refer us to [rehabilitation unit]. Well it’s a big centre, and because there’s such a long waiting list, they wanted us to start the paperwork straight away. For Daniel’s needs that was going to be the best hospital, the best rehabilitation.
So we said, “Yes, fine, you know, start the procedure.” So we never knew when they were going to take off sedation, they didn’t ever let us know. But the next day when we went in his girlfriend, Daniel’s girlfriend and brother went in to see him, and they came running out and said Daniel had opened his eyes. And we were ecstatic. And I thought this is it. This is it. You know, he’s back with us. Totally naïve in how a traumatic brain injury affects. And of course, although his eyes were open, he wasn’t aware. And I definitely wasn’t aware that just by having your eyes open, it doesn’t mean to say that you have any knowledge or recognition of anyone.
Some people spent time in intensive care or high dependency units where they were kept away from other patients and visitors. This could be an isolating and lonely experience for those who were conscious, although Louise, who was in an isolation unit for weeks, described how she felt very emotional and cried a lot with relief during this time.
Depending on the type and severity of their injuries people needed different treatments or interventions. Some injuries were left untreated because they would heal better on their own. Instead of surgery Simon B’s treatment for a spinal cord injury was ‘conservative management’, which involved stretching his vertebrae. Some people had several life-saving operations and procedures, including limb reconstruction or amputation, muscle, nerve or skin grafts, head and brain surgery (to remove fluid and clots), and orthopaedic operations (to insert titanium rods or plates to rejoin breaks and encourage bones to mesh together).
Nick Z broke his neck in a motorbike crash. He needed surgery to reconstruct it using rods and...
Nick Z broke his neck in a motorbike crash. He needed surgery to reconstruct it using rods and...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well at the race track, I had first aid. So my helmet was removed, and I think I had to be resuscitated, and then at hospital in Spain, I had my neck fixed. So I broke my neck and one of the discs in my neck popped out and into my spinal cavity, and injured my spinal cord. So it happened at the middle level of my neck between the fifth and the sixth vertebraes. So they took the disc out and fixed my neck with come steel rods and a plate, which was fixed with screws. And my lungs ceased working so I had respiratory failure, so they had to put me on a ventilator, so I had a hole in my neck and was on ventilation. And I think I was unconscious for quite a long time.
People also had operations to implant aids and prostheses, including hearing aids, contact lenses and catheters.
Juri had two operations on his eye. He thinks one was to remove the broken glass from it and the...
Juri had two operations on his eye. He thinks one was to remove the broken glass from it and the...
SHOW TEXT VERSION
PRINT TRANSCRIPT
And what was going through your mind at that time?
Am I going to see again? Because it was all dark and I kept touching it, because I couldn’t believe it, you know. And then everything happened really fast after the accident. The ambulance came and they took me to the hospital. I went into the bathroom at the hospital and I started putting water on the eye because I wanted to try and clear it. I thought that the blood maybe was the reason why I couldn’t see. But it didn’t do anything good and I just waited for, and then I don’t remember anything from there. They gave me a lot of morphine for the next week or something like that. And I guess there were two operations, I think, in that week. I don’t remember much.
Okay and so can you tell me more about the operations you had at that time?
You know I don’t remember much. I think they asked me if I wanted to get a local anaesthetic or a total and I went for the total, because I didn’t want to look at the operation while it was going on. And then nothing. I just remember going to the, to the operation room and they give me something to relax for ten seconds, and then it knocked me out and that’s it. The first operation I don’t remember, though.
Right was that done on that night?
The first operation yes, was done at a hospital near [place], I think. I’m not sure though. And the second one was done at [place].
Right. And do you know what the aim of the first operation was?
The…?
The aim, the reason for it. What were they trying to do?
Maybe take the glass off the eye. And the second one was to try and adjust it I think. Or to implant the contact lens maybe.
He had a catheter fitted on admittance to hospital, but several months after his spinal cord...
He had a catheter fitted on admittance to hospital, but several months after his spinal cord...
SHOW TEXT VERSION
PRINT TRANSCRIPT
It was done under epidural, under I suppose you’d describe it as local anaesthetic. So it was done in operating theatre, epidural in my back and then, yes, the insertion of the, the suprapubic catheter. I do remember that following insertion there were certainly a couple of days when you have large saline bags to wash through the, the bladder, because there is obviously some trauma associated with insertion of a suprapubic catheter. So it can be a little bit alarming that, you know, there is a degree of blood in the urine and, and certainly it’s discoloured to start with. And it takes a bit to wash that through.
Did you, did you have a saline drip in your arm so that you had more fluids going in or was it a saline wash-out?
It was, it, it was a saline wash-out. So I think that the urethral catheter was still left in for a day or two so that saline, or whether it was saline, water was passed through the bladder so that it kept flushing through and, was able to, to, to get rid of that trauma at the time. Obviously that is, that was quite a disconcerting sight. It was, you know, for a day or so, bladder, you know, blood passing through your bladder. But you’re told to expect that. So, you know, it tends to clear up within 24, 48 hours.
Yes, I think I was reticent although I knew it was necessary. I think independence in urinating is, is something everybody takes for granted, and to be in a situation where, you know, something’s going to be put, put into your bladder permanently is, is something you’d, you’d rather not happen. But when faced with relatively few alternatives, I wasn’t able to self-catheterise, so that was a decision that was come to that was the best way to, to manage my inability to urinate or control urination myself.
The treatment decisions people faced could be distressing. For example, those who sustained significant damage to their legs in road traffic collisions were asked whether they wanted to have reconstructive surgery (in which their legs would be rebuilt) or have their damaged limb amputated. While initially wanting reconstructive surgery, they either eventually opted for amputation or it later became necessary after the reconstruction failed. When they were comatose or sedated, treatment decisions were made on people’s behalf by hospital staff or family members.
Medication was prescribed depending on the severity and type of their injury and the problems resulting from it. Drugs were used to treat pain, infections, depression, seizures and psychiatric problems. Different types of anti-depressant medication were commonly taken. A man with a brain injury (Interview 7) said he felt he took so many pills he “rattled” when he walked. Finding the right medication involved some trial and error, and people said it was important to be guided by specialists. Medication changed over time as people’s needs changed and they decided which side effects they could not tolerate.
The side effects of his antispasmodic medication were too much. Nick Z chose to reduce his...
The side effects of his antispasmodic medication were too much. Nick Z chose to reduce his...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Do you take any medication for the spasms?
Yeah, I do, I take quite a lot of medication and they have quite nasty side effects. So they cause drowsiness and loss of memory and indecisiveness and I did get to the point with my anti-spasm medication, where I felt it was affecting my mental state so much that I cut the dosages in half. And, although my spasms got worse, they were tolerable and I decided to live with, you know, a higher level of spasms, but a lower level of mental disturbance. So it’s, so it’s quite difficult to get the right balance and I now have a cocktail of drugs rather than relying on one, which I think also helps.
And when you decided to reduce your dose did you do that with medical advice?
Yes.
And…
Well no, I told my clinicians that I wasn’t prepared to live with the level of mental disturbance that I was experiencing, and so they agreed to reduce the dosage of the Baclofen and increase the dose of the other two.
Tell me a little bit more about the, sort of the mental disturbance that you experienced when you were taking the higher dosage of the Baclofen?
Well I mean it’s worst manifestation was finding myself in a state of torpor. I would be sitting somewhere just staring out of the window and not really knowing why. And I can remember, just before I decided to do something about it, realising that my mobile phone was ringing and picking it up, and it was my brother calling and he said, you know, “What are you doing?” And for a while I didn’t know how to answer him. And I didn’t know how long I’d been there or what I would have done if my brother hadn’t called, and that’s, I think, when I realised that I had to do something about it.
When he was in hospital, Ambrose had morphine injections. He said some nurses were good at...
When he was in hospital, Ambrose had morphine injections. He said some nurses were good at...
SHOW TEXT VERSION
PRINT TRANSCRIPT
You said at the start as well in the initial operation or may be just after that you were getting morphine injections.
Yes.
And you said that some were good, and some were bad. Can you tell me what you meant?
It was the technique. Because it has to be injected into the muscle some people were very good at doing intramuscular injections and some people weren’t very good at doing intramuscular injections. And you know because it is you know, a motor skill some people would be good at it, and some people won’t be so good at it. Because you know, obviously if people have had that sort of injection you know that it’s always going to be uncomfortable but it’s a difference between you know it’s had it done or it really hurts. But you know, you could always rationalise that of okay well it’s hurting but what she’s just stuck in my leg is a painkiller, so it’s only going to hurt for a little while. But it was just that thing of, you know, if you’d, if you’re in bad pain and all you want is just the painkiller like, if it’s really, really hurting and then somebody else does something else that hurts as well then it just… I think it was just where there was such a difference between people who did it well, and people who didn’t do it well and you’d see who was coming at the bed with a tray in their hand and you’re either thinking, oh yeah, she’s knows what she’s doing or oh no, okay. And just prepare yourself for, it’s all going to be lovely or it’s going to be okay.
The medication Bill was prescribed in hospital was not working for him, so he decided to stop...
The medication Bill was prescribed in hospital was not working for him, so he decided to stop...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Bill' When I was in hospital after the amputation there was a pain specialist and by the way, if you are in pain please as your GP to refer you to pain specialist because they’re the experts and will hopefully sort your pain out. But one of the things that happened this same guy that I was under who was brilliant by the way, a real cor blimey bloke, you know, but he was fantastic, very knowledgeable. And he was involved at the start, but I didn’t even know, it was just on the paperwork. I never met him. I met him later on. And what he said was that it was all introduced, all the drugs that he’d, he’d suggested that should be given to me were introduced in the wrong manner. They weren’t titrated in, they weren’t fed in, they were bits and bits. So I got to the point where, and this is another disconcerting thing which I think I suggested earlier on about the in, the injury when it was vacuum packed in plastic as well. If you could imagine that vacuum pack, in a stump and that stump being cold, so you go to the chill cabinet and you pick up that gammon and you feel the, the temperature of it, it’s cold and its plasticky and you put it in the basket and that’s what my stump felt like because they did it in the wrong manner.
So eventually it was sending me to distraction, wasn’t it? Absolute distraction, because you try to hit and try to get some feeling into it, but it wasn’t, it was dead. And I think what was happening was that it wasn’t done in here, all the drugs were up here and numbing the receptors of our brain as to what’s going on down here.
And eventually I said, “Bugger this.” And I stopped taking my medication. Totally got it out of my system and all the phantom came back and that started to drive me to distraction again but I had a way out. Do I want the phantom pain or do I want the gammon, the cold gammon? And I’d rather the phantom pain because at least I felt it. I couldn’t feel anything with the gammon.
But then I got a referral to the pain clinic and explained all this to them and they said it was done in the wrong way, let’s do it again. And he started introducing all this stuff again and …
Catherine' Very slowly.
Bill' Very slowly. Introducing it, and also of a sudden it was oh that’s good, oh that’s better. A new dose. That was better still, new drug, that was good. And, you know, before you knew it I’m on an awful lot of medication. But at least it was re-introduced and got me to a point where I can cope.
Another thing about medication of course is you’ve got to get to a point where the medication will do the work but allow you to do things in life as well. It’s pointless having the medication and getting rid of all the pain, but you’re comatose and you can’t do anything. At all. So it’s a trade-off between what’s enough but what’s doing the job, and what can you cope with painwise, to what you can do in your life. So it’s always a trade off. Always a trade off. And you know, I’ve got to that trade off position, but it has consequences. Everything has got consequences yes.
The potential side effects of medication (antidepressants, anti-seizure medications and medication to treat spasms) put people off taking them. They reported experiencing a range of physical and psychological side effects from the medication, including feeling “drowzy”, “zombified” or “hungover” (John and Jack). They said it clouded their thought processes, made them forgetful and caused them to feel like they “couldn’t be bothered” (Louise). Other side effects included upset stomachs, heartburn, diarrhoea or constipation, weight gain, sweating, hallucinations, dry mouths, feeling tired, lightheaded, and unsteady. People did not always like taking medication, but understood it was necessary to ease their symptoms or aid their recovery. Aiden refused pain medication because he was concerned about long term side effects. Sometimes people turned to alternative therapies or changed their lifestyle, but some questioned whether any improvement it made was just a placebo effect. It could also be difficult to disentangle side effects of medication from symptoms of injury, or simply getting older.
Since her injury, Elcena changed her lifestyle and diet because she does not like to take...
Since her injury, Elcena changed her lifestyle and diet because she does not like to take...
SHOW TEXT VERSION
PRINT TRANSCRIPT
I would just take some paracetamol if that, but if something more, then I need go to the doctor and get some co-proxamol, something different. Most important is that is actually looking after yourself, alternative to what you do, it’s actually looking after yourself. For instance, yes, I like going to meetings, but in your preparing for your meetings, don’t rush, don’t worry, because there’s always time to catch up once you get there. It’s good to be on time, but all these have to do with your wellbeing, your welfare, instead of always taking tablets and worrying about them, calm, you know, calm. It’s not going to go away. Alternative is a different method of looking after yourself, a different method of feeling, just invent a better of feeling, imagine yourself somewhere that is different. It’s not too difficult to do, because if you’re living with pain all the time, even now and then you just wish it would go away, you just calmly sit down, and you just listen for it. It’s gone. It’s there, but you’re there too, and once you learn these little techniques after a while you practice them and feel a little better in yourself. It doesn’t stop things. Like I said before that if I take, if I’m going to start walking, soon I walk a little way, without anything my leg is going to start to tell me, because I will start dragging behind me, my shoe’s trying to fall off my foot, you know, they do. Then I say to myself it’s time, you know. You get to know your body, and alternative medicine mean you learn to know your body and when it’s talking to you, you listen. And this is something that individual have to learn themselves. It makes a lot of difference.
There was some concern among staff, patients and families about infections developing whilst they were in hospital. Nick Z had operations not typically related to spinal cord injury, such as having his oesophagus rebuilt after getting an ulcer in his windpipe. Sometimes family members were involved in caring for them.
Catherine, a former nurse, cared for her husband (Bill) in hospital. Although he received good...
Catherine, a former nurse, cared for her husband (Bill) in hospital. Although he received good...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Catherine: I started caring for Bill as soon as I went into the hospital.
I didn’t do so much in Casualty because I was in a state of shock. But when he went up to the ward he didn’t go straight to theatre like they were originally planning, and so he was delayed, I think by about six hours weren’t you?
Bill: Yes.
Catherine: So he went up onto a ward. On one occasion, his, his sheets did need changing on that evening. And this is the case where nobody would do it because of the mess of his leg and just didn’t want to move him and also because of him being so big, but in the end…
Bill: Cheeky.
Catherine: In the end I got the sheets and we did it between us didn’t we? We managed to do it.
Bill: Yes.
Catherine: And when they came back the nurses it was like done, you know. “All on your own?” “Yes.” You know. So I was very wary of the care. The caring in ITU was good I think it usually is, although sometimes they didn’t react to things as quickly as what I would have done, they sort of let them go on a bit longer. And then the ward after ITU I was helping you dressing, washing and exercises.
And the care continued throughout his stay, especially at [hospital]. Especially at the next hospital where he rehabilitated. They had a lot of MRSA there and they were not segregated, these MRSA patients. They were allowed to use the same bathrooms as the patients without MRSA. And Bill with all these open wounds – he had an infection on his skin graft and the stump still hadn’t really healed – there was no way I was letting him into the general bathroom that was being used by MRSA patients. So what we used to do is that, he used to have a strip wash and he used to come for weekend leave, didn’t you, and we’d get him in the bath then, although he wasn’t supposed to go upstairs initially, but...
Bill: I shouldn’t have gone in the bath either, I was a very naughty patient.
Many people had little recollection of the early part of their time in hospital because they were unconscious, medicated or experienced amnesia. People could be in a lot of pain at this time; even having dressings changed on wounds was described as very painful. Some spent the time in hospital coming to terms with what happened. They wondered how their injury would affect them practically and physically. Dave felt the news that he was paralysed was given to him in a “blasé” way and he would have liked the consultant to be a little less certain to allow him some optimism about the future. In other cases, consultants were not able to give much information about potential recovery and this could be unsettling for the person and their family. One man, who was concerned about whether he would be able to have sex after his spinal injury, said, “I had sex in hospital. As soon as I realised that I could still get it up, it was one of the first things I was doing.”
Bridget’s father told her that her partner had been killed in the car crash. She said it was one...
Bridget’s father told her that her partner had been killed in the car crash. She said it was one...
SHOW TEXT VERSION
PRINT TRANSCRIPT
And your partner was killed in the car accident?
Yeah.
And that must have been absolutely devastating.
Well it’s interesting because I have been told subsequently that I didn’t remember that he’d been killed. So, when I was in hospital and I had, after I was unconscious, and I think I was conscious I was unconscious for a long time, like a few weeks rather than days. When I did finally come round I kept asking about him. And I’ll never forget that was one of the things my father had told me, that he was the one who the hospital just said somebody’s got to tell her, so he was the one who had to tell me that he had died. So he said that was one of the hardest things he’s ever had to do.
After hospital, people went home or to rehabilitation, but often had to return to hospital for specialist treatments or regular health checks; Louise goes to hospital for steroid injections to help heal her burns and treat the itching she experiences. Others required further operations. For example, Bill and Jack had their amputations revised, which involved removing part of their stumps. Marina said the hospital staff describe her son Daniel as “their star patient…and everyone comes running to see him” when he goes back there. For some people, the extent of the injury was not immediately apparent and it was several months before they were fully diagnosed and received hospital treatment.
Last reviewed October 2015.
Last reviewed October 2015.
Copyright © 2024 University of Oxford. All rights reserved.