The World I Fell Out Of. Andrew Marr

our semi-naked bodies, big, small, and everything in between, were hoisted onto commode-style shower chairs and wheeled into the bathroom one after another, to be poised over the loo until our bowels delivered. There was a critical time balance as to how long you waited. Left in bed too long, you would poo on the sheets or, worse, in the hoist; or perhaps even dump upon the floor through the hole in the shower chair seat en route to the bathroom. Too short a time, and you would sit for what seemed like hours over the loo, waiting for the splash that told you something had happened. It was the only way to tell. You had no feeling.

      Eventually, a staff nurse would come and use a gloved finger to check that your bowels were empty; and then you would be showered. Often your bowels didn’t oblige and after half an hour or so, with you cold and acutely miserable on the hard plastic split seat of a shower chair, a staff nurse would come and put their fingers up your anus, stimulating the rectum until it released. Some nurses were better at it than others. They were the ones you loved because they were fast, efficient and gave you confidence that you would last the day without an accident. The ever-cheery Rosebud, one of my favourites, used to waggle her index finger and joke that she should have it insured as one of the best in the business. Without the willingness of spinal nurses to put their hands up dozens of backsides a day, closing their noses to the smell of faeces, the paralysed would die. It’s as simple as that. Perhaps it’s no surprise that death rates for spinal injuries improved after the invention of the disposable latex glove in the 1960s.

      They gave as good as they got, those fast-talking, insouciant Glasgow girls. Lupin, her uniform straining over her fabulous bust, had spent the morning crouching on the floors of bathrooms, beside arse after arse, evacuating poo. Later she sounded off to some of us, the patients she trusted, about being criticised by one of the consultants.

      ‘He’s like complaining it was too smelly when he was doing the ward round.’

      She threw her hands out, paused for effect.

      ‘I’m like, “No shit Sherlock!”’

      ‘Did you really say that?’

      ‘You kidding?’

      For us, new trainees in the hard school of double incontinence, this was the start of an entirely different way of life. We laughed about our plight when things went particularly wrong, forged together by the dark humour, the dry-as-dust jokes, the human condition stripped to its most primitive. It was, I guess, like a PoW camp. With it went an undercurrent of real camaraderie, a shared acknowledgement of our common misery. Up and dressed one mid-afternoon, a dozen or so of us were parked in our wheelchairs in a polite semicircle, staring at the wall onto which was projected the first slide of a PowerPoint presentation. And one of our number, a distinguished man who had boarded a plane at Heathrow but when it landed was unable to stand up because he had suffered a spinal stroke, leant over from his wheelchair towards mine and muttered:

      ‘Did you ever imagine a situation where you would sit gazing intently at the words “Bowel Management”?’

      Indeed, there were far too many things beyond the power of imagination and they were pressing in on us. We got detailed tutorials. We were as mordant as we could be, for without a highly developed sense of the ridiculous, how else could we cope with bleak forty-five-minute lectures about suppositories, peristalsis and sphincters; or indeed, in subsequent sessions, about pressure sores, catheterisation techniques and the risks of a deadly condition called autonomic dysreflexia? We were awake yet trapped in an undergraduate’s anxiety nightmare, where you dream you’ve committed to study entirely the wrong course. There had been some terrible mistake. You wanted to do English Literature; you were stuck in theoretical astrophysics. And in this university there was no dropping out, no transferring. To this day, I have lodged in my memory one particular giant image of a bedsore on a buttock which was displayed on the wall for us during those afternoon education sessions.

      ‘This sore is the size of a plate,’ warned the nurse in charge.

      ‘It had to be packed every day and the person had to spend two years in bed before they were able to sit up in a chair again. It is what can happen if you do not check your skin and take efforts to relieve pressure points.’

      I looked at plates differently after that.

      Most definitely beyond imagination were the backstories of my fellow patients: the extraordinary mixture of bizarre and mundane which had brought us together. We were a community bound by the common possession of crushed or severed spinal cords, but the disparate tales of how it came to happen were far, far stranger than fiction. Any woman who has given birth in an NHS hospital will know what it’s like to share a ward with the fantastic, comic mix of rough and ready, posh and precious, and every kind of female in between, whose only common bond is the ability to have a baby. Well, breaking your back is like that but magnified a millionfold. If you tried, you could not have made us up. Academics, labourers, wasters, tradesmen, accountants, failed suicides, business managers, teenagers, drunks, cyclists, stuntmen, farmers, speedway riders, criminals, jockeys, teachers, police officers, motorbikers, dog-walkers, golfers, drug addicts, teachers, pensioners and more congregate in spinal units. We were young, old, decrepit, well-groomed, inarticulate, intellectual, deranged, gay, straight and transgender, condemned to our wheelchairs by road accidents, falls from bikes or horses or walls or beds or cliffs or balconies, stumbles off kerbs, trips over slippers or coffee table or dog leads or manhole covers, crashes on the piste, dives into swimming pools, rugby tackles, violent assaults, attempted murder, war, vascular incidents or complications from tumour operations. Several were victims of slipping on ice. Men outnumbered women by almost ten to one. Every one of us had our own bitter misinterpretation of risk to reflect on. What we had in common is that life, quite simply, chose to leap out and attack us. As one nurse put it: ‘When I first came to work here I was terrified of the chance of spinal injury happening. Then I saw that it can happen to anyone, in any circumstance. It is completely random so I stopped worrying.’

      This did not stop us, as individuals, in private moments, being haunted by our ‘what ifs’. What if I’d left the bike at home. Or pulled up the horse. Or not got in the car. But such thoughts were entirely pointless, jousting with the random essence of existence. Meantime, I decided, even if I couldn’t move, there was at least some fleeting entertainment to be had watching and listening to my fellow travellers. It was, I supposed, like being on a cruise ship.

      The rehab ward was subdivided into rooms of four or six beds. One of these, opposite the nurses’ station, was a dedicated respiratory section for those poor sods who were on tracheotomies in order to breathe. They remained strangers to most of us, as they never rose from bed to wheelchair, and were too sick and dependent to reach the gym. People with such high-level neck injuries stayed as long as it took to stabilise them and arrange the massive twenty-four/seven care packages they would need at home. Then they were taken away at quiet times: still, distant figures upon stretchers beset by tubes and ventilators.

      I remember catching a glimpse through the internal ward glass of one occupant: a morbidly obese man, not old by any means, who lay like a mountain upon what seemed an impossibly small bed, the tubes through the front of his throat, his face turned impassively towards the outside window. He did not live long enough to go home: one morning the staff came and drew all the internal curtains in the wards, shut the doors and hushed our buzzers, because his body was being removed and we were not to see. His accident had probably been caused by a fall – the most common cause of calamity. But oh what variety was contained within that tiny little word ‘fall’: it included everything from failed suicide to a trip over the coffee table in the living room after, or even before, a glass of wine, or sometimes six. All of human life was there in the lurid, eye-popping diversity of falling. There was Del, a part-time brickie and a full-time wild man, who had swallow-dived from the seventh floor on holiday in the Costas, convinced by drugs and alcohol he could fly. Despite his injuries, I think he still thought he could. He also thought he was irresistible to women and was famous for making lecherous comments to staff and female patients. Some weeks later, when I was upright in the gym on a static wooden standing frame, braced upright between foam knee braces and leather straps behind my bottom, I became aware of Del in his wheelchair at my right hip, leering.

      ‘You