Life goes on

You can go with the flow. For me, a trip to the loo meant a life-saving dash by ambulance

When you're paralysed, you lose control of a lot of things. Including peeing. (I hope my readers aren't too squeamish - I promise not to venture into the area of bowel management.) Well, peeing is accomplished via a plastic tube, a catheter, attached to a bag strapped to a leg. For men, a catheter can be attached with something resembling a condom or, as in my case, a hole can be drilled directly into the bladder. This is a supra-pubic catheter and mine is changed every month, usually by a district nurse.

Except on this occasion she couldn't. She had withdrawn the old catheter but the new one wouldn't go through the hole, no matter how gently she tried to thread it. Either the hole was beginning to close up - it can do this with alarming speed - or my muscles had gone into spasm and were refusing to cooperate.

Another thing that happens when you are paralysed and without feeling is that your body lacks the normal feedback mechanisms to tell you it is suffering discomfort. Instead, your blood pressure goes up and you start to sweat. As it rises you develop an excruciating headache and you are in danger of having a stroke. This catch-all warning mechanism is known as autonomic dysreflexia. I was beginning to sweat.

Of course, if the pressure in my bladder could be relieved by the more conventional route, the day would be saved. The nurse decided to insert a catheter through the urethra (was that the sound of countless men jamming their knees together?) but spasm again thwarted the operation and the expected flow was not forthcoming. It was time to call the hospital spinal unit for advice, which was: "Get here as soon as possible!" I just had time to get dressed before I was bundled into the ambulance.

As luck would have it, the consultant urologist was in and was captured by the nurse in charge of outpatients. My autonomic dys-reflexia had subsided as my bladder had taken the pragmatic decision of relieving the pressure through the only means of egress available to it: the hole in my belly. My clothes were soaked but, fortunately, my wife, fearing such an eventuality, had brought replacements.

The urologist was a Yorkshire man for whom the word phlegmatic could have been coined. Having determined that I normally used a size-16 catheter, he tried a 14-gauge to see if the hole would tolerate it: it wouldn't. "I'll try a 12. If that doesn't work, I'm afraid we're going to have to give you a spinal and drill a new hole."

The gods (I don't know which ones, so I thank them indiscriminately) were on my side and the 12-gauge worked. To enlarge the hole, the 12 was replaced by a 14, which in turn was replaced by my familiar size 16 and all was well.

Well, nearly. My blood pressure had decided to protest and was now so low that I was in danger of passing out. I lay on the bed for a while (keeping your head low is the prescribed treatment) but the outpatients department was closing and the nurse couldn't hang on because she "had the builders coming". I would have to go up to one of the wards until the fainting fit passed.

There was only one problem with this course of action: it would expose me to the wrath of the very people I had been slagging off in my recent columns. Some of the consultants had let it be known that they were upset by remarks I had made about the lack of sensitivity of spinal units to the emotional state of patients with serious back injuries as they came to grips with the cataclysm that had befallen them. If I bumped into any of them I would have to make amends, especially since one of their colleagues had just saved my bacon. Could I remain anonymous under a blanket like the people you see on TV being shuffled into a police van? Unlikely.

I was whisked upstairs as discreetly as possible. No sign of them in the corridors or the ward. My wheelchair was propped on pillows against a bed and I spent the next hour perched in this apparently precarious (though in fact quite safe) position, hoping against hope that I would escape unscathed.

As it turned out, the consultants were nowhere to be seen and, to my surprise, I was welcomed like a long-lost friend by the nurses. Later I slipped out as easily as I had entered and made off home. Either these nurses really are angels, or they don't read my column.

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