The World I Fell Out Of. Andrew Marr

of my brain, I was horrified – my illiberal subconscious was betraying me, my inner Daily Mail reader emerging. The other part of me was preoccupied with the need to tell the authorities. Surely they shouldn’t be there. Not living in the ceiling. I knew things were bad in the NHS but surely not that bad. I felt under threat. But before I could call out, express it, the morphine carried me away somewhere else, and I forgot.

      For three days, over the Easter holiday weekend, I lay motionless in the high-dependency ward of the spinal unit, waiting for my surgery. They had me on a specialist spinal bed, which tilted from side to side, to relieve pressure on my skin, and I was allowed neither to eat nor drink. Every so often the nurses wet my lips with a sponge on a stick. I pleaded for water, but they could not give me any. I pleaded with them to turn my pillow, to relieve the pressure on my head, but they refused to do it as often as I would like, because the neck was unstable. It took three of them to do it – two keeping my head motionless. The other one flipping the pillow. For three days I was unaware of anything else from the real world. I don’t know if Dave was there; I drifted.

      My only certainty was that the ward was a dangerous, volatile place and I was a silent witness, buffeted and bewildered by the drugs. My instinct was to hang onto consciousness and concentrate very hard on survival. My view, when I was with it enough to open my eyes, was still that bit of ceiling. Out of the dark, in the periphery of my vision, emerged a face. A tiny woman with short grey hair; a kindly, self-effacing sprite whose voice offered me a mooring. ‘I’m Christine. I’m your named nurse,’ she told me. ‘I’ll look after you now. Together, we’ll get you through this. Things are going to get better.’

      The connection she made held me, steadied me, a rope to the shore. She told me she had been a spinal nurse for more than forty years; she spoke with confidence and calm optimism. When she was not there I drifted alone again, fearful. Over the time I spent in hospital, I was cared for by dozens of nurses who were, like all human beings, a mixture of sensitive and insensitive, flawed and uncannily dedicated. With all of them, I sought kindness and a connection; the essence, surely, of any benign human relationship. And with most I found it, with few it was lacking. There was no other nurse, though, who gave me utmost sanctuary in the way Christine did when I was most in need.

      Days and nights merged and I was unaware.

      I could not feel my body, but I sensed strongly that my legs were raised up in the air in front of me. Floating up high. Later I learnt this was a common phenomenon of a new spinal injury, because they weren’t; they were flat on the bed. The other pressing physical sensation was of a steel band tightening around my ribcage, like the hoop holding together a whisky barrel. I could feel nothing else in my torso but that band. Most peculiar. Later I discovered this was my diaphragm. Our bodies, brilliantly evolved to survive, breathe in two ways – via the intercostal muscles around the lungs, and by the action of the diaphragm. The connections for each emerge from the spinal cord at different levels, like a safety net, a fallback system: I had lost the first but retained the second. My injury had paralysed my chest muscles and I was breathing solely by the rise and fall of my diaphragm. Had the break happened a few millimetres higher, both would have been knocked out and I’d have needed a tracheotomy and a machine to breathe for me. But I didn’t know this. I knew very little. I had no skin sensation at all … could only feel my head and back of my neck on the pillow. Just to test I was alive, and to release some distress, I chewed angrily at my bottom lip, the only autonomous action left to me. Just then I vividly appreciated the attraction of self-harm. Soon I could taste blood, but felt absolutely no pain. Why wasn’t it hurting? Only much later did I realise that this was the effect of the morphine.

      Because my neck was unstable, they needed to secure the vertebrae at the front with a small metal plate. Before the operation, there were chats, which I only very vaguely remember, with both the anaesthetist and the neurosurgeon. The operation was tricky because my neck had swollen so much that from the ears down my neck flared out towards my shoulders, like some monstrous steroid-happy body-builder. It looked so grotesque Dave did not allow Dougie to visit me for several days.

      ‘You made an international prop forward look swan-necked.’

      So swollen was my throat that the act of intubating me for the anaesthetic was risky and the operation, to plate the front of my sixth cervical vertebrae, took several hours. Afterwards they were worried that my throat would close up with the additional trauma, so they kept me on a ventilator to breathe for me, a big fat air tube in through my mouth and down into my lungs, and I was even more sedated. I couldn’t speak. A drip fed my body with fluid; a catheter drained it out. Of all this I was oblivious. I also had a nasal-gastric tube up my nose and down my throat, through which they passed the ground-up drugs into my stomach. When I was with-it enough to cry, the tears ran into my ears and soaked the tape securing the feeding tube to my face. I could do nothing about this; it was the same exquisite misery as when you have a streaming cold but are unable to blow your nose. The only thing to do was try not to cry. Christine had told me things would get better and she never let me down – I just had to take shelter in my head and hang on.

      To enable me to communicate while on the ventilator, the nurses hung a laminated card with an alphabet by my right arm. After my fall, Pam, a dear friend of many years, rushed from France to support Dave. I have snatches of memory of them both at my bedside, with me conducting irritable, faltering mime conversations with them, spelling out the words by waving my right forefinger at the letters. My mind – I was convinced – was as clear as a bell; I became increasingly exasperated when they failed to keep up with my slow-motion spelling and grasp the words. They can’t be this stupid, I thought crossly. One day they arrived and said happy birthday – I remember feeling a genuine sense of shock and surprise. My birthday was 13 April, surely not yet. But I had lost control of time; I’d been on a ventilator for more than a week and the sound of its rhythm, sucking and sighing, the persistent beep-beep-debeepbeep behind my head, had become the vortex of my entire life. My real world was inside the apricot. I waited, while the scene changes came thick and fast and the only constant was the machine, sighing and pinging apologetically.

      Some nights, my bed was in the corner of a room that was being used for a party. They’d opened an Indian restaurant on the ward. There were vast buffets of curry spread out, people came and went, laughing. My bed kept being moved. Every day I was in a different room and strived to orientate myself. One night I had a bird’s-eye view overlooking a city, which lay across the curve of a bay. In the dark the lights of the city were twinkling, reflecting across the water. Another night, workmen, wearing high-vis jackets, were digging up the floor around me. Then my bed split in two across the middle and I was sliding down into the gap, suspended over dark, deep water, and I kept crying out to the nurses to tell them I was going to drown, but they didn’t understand. One nurse was lying on the floor behind my bed snogging a workman. Another night, I was kidnapped – strangers used a fork-lift truck to take me, on my bed, out the back of the ward and stow me in a horsebox. They wanted me to go back to the cross-country course and testify that my accident was not their fault.

      A family game from childhood haunted me, the rhyme shimmying around in my head. It had come from my mother, who played it in Northern Ireland in the 1920s on the way to picnics on the beach, sometimes Tyrella, sometimes Ballywalter. We played it too, obediently, on the back seat of the car. You crossed two fingers from one hand, opened a little, over the two fingers on the other hand, creating a neat, square, inviting hole in the middle. As you offered the gap to the person next to you, you chanted:

      Put your finger in the crow’s nest

      The crow’s not at home

      He’s gone to Ballywalter to gather shelly stones …

      And then, squeezing on the other person’s finger, you shouted:

      He’s coming

      He’s coming

      He’s nipping!

      He’s nipping!

      And you squeezed and squeezed, and held them, trapped tight by the finger, until they squealed for mercy.

      At one of the ward rounds, in a window of comparative sanity, I remember meeting