14 The Times Magazine
an eight and a half out of ten, so right up
there. I effectively had to fix his pelvis back
together and reattach it to his lower spine. All
the major blood vessels that run to the lower
limbs into the thorax run through the pelvis
and you’ve got your bladder, your sexual
organs depending on your gender... There’s
quite a lot of stuff contained in that small area.
The sacrum is a block of bone at the base
of the spine forming the back of the bony ring
of the pelvis. His had fractured in four places.
His left side had cracked from top to bottom.
All the soft tissue at the front and back of
the joint on the right side had completely
disassociated. The front of the pelvis, where
it meets the pubis, had ripped apart, so the
whole right side of the pelvis was effectively
hanging off. You can bleed your whole
blood volume into your pelvis and die.
The important thing was to make the pelvis
into a ring again and make it stable, so that
when he’s moved in the ICU it doesn’t cause
more injury, and the spikes of bone aren’t
digging into more blood vessels and causing
more problems.
In that operation, it’s a question of planning
what we do and potentially how we bale out.
If the anaesthetist tells me he’s bleeding out,
or his blood isn’t clotting properly, what are
my really quick get out of jail options? We
had a small window of opportunity after the
accident and before the inflammatory process
starts up to stabilise him.
There were three surgeons that day: there
are a lot of retractors and things to be held so
you need a few pairs of hands. We fixed the
right side of the bone back together to make
the right side of the pelvis one piece using a
plate and some screws made of stainless steel.
The longest are 120mm long and 6.5mm in
diameter. They stay in place for ever.
The order in which you do it is quite tricky.
I fixed the right side back into one piece, then
pulled it together at the front temporarily with
a clamp. I needed to get the back aligned, the
weight-bearing bit between the hip and the
spine, because that will give him the best
prognosis long-term. If it isn’t aligned, he’ll
suffer chronic pain. My main worry was first
making sure that he lives, but my next worry
is getting the back aligned. I put an external
frame on, with pins through the skin into the
bone and a carbon fibre bar across to keep the
two sides of the pelvis together. Then I pulled.
His pelvis had dropped backwards and I needed
to pull it back up and get it into the right
place. It’s hard work; it’s like water-skiing. You
are effectively trying to pull him off the table.
I like music in my operating theatre, so we
had Nineties rock, quite high-energy singalong
stuff. Bon Jovi, AC/DC. It’s still a workplace
and we’re doing our jobs; it’s just a bit different
from what other people do. The big thing is
to get the bones stable without causing further
injury to the nerves. The whole operation took
about six and a half hours, but I lose track of
time. When we finally got him closed, I was
really happy with the position we got him
back into. I didn’t think I could do it better,
and chasing perfection comes at a cost:
I might end up making it worse, or causing
him more problems by operating for another
three hours.
The pelvis is an incredibly strong bone,
so the energy involved in doing the type of
destruction that Danilo had is enormous. It’s
difficult for patients who undergo trauma like
this, because one second everything is normal;
the next, they’re in pieces. It’s incredibly
rewarding putting people back together. There
are times when you just can’t, but sometimes
you see people like Danilo, who are literally
dying unless someone does something. To
have the privilege of being one of the people
who helps him not to die is incredible.Niamh Spratt-Murphy, 27, occupational
therapist at St Mary’s at the time of the accidenturgeons put people back together, but
my job is to come in and figure out how
you’re going to become able to put your
socks on or get into a chair. The goal is
to make someone as independent as possible.
When Danilo first came to us in August
from the ICU, he was bed-bound. He had
been lying there intubated and sedated, and
his muscles were wasting away. He hadn’t got
out of bed at all. The first step was seeing if
I could help him get out of bed.
Here was a young guy lying in a hospital
bed for 23 hours of the day, on a ward with
people who were not his age, in the midst of
the pandemic. It was really tough on his mood
and his motivation was low. My initial worry
with Danilo was, is he even going to engage
with what I want him to do?
We struck a chord because we’re very
similar ages. I became his sounding board.
From the get-go he would say, “This doctor’s
said I can go home when I can walk. Will
I walk again? When can I go home?” We had to
have some really honest conversations, saying
we don’t know how you’re going to progress.
I knew it would be difficult for him to
walk again. I had seen his scans and they
were scary. He was definitely one of the worst
motorcycle accidents I had seen in a while.
But you have to see the person first before
you see the injury – get to know them, buildup the rapport. Because when you’re saying
to someone, “You’re going to be able to stand
and I’m going to help support you,” they
have to trust you that they’re not going
to fall. Danilo trusted me, definitely.
Obviously, his overall goal was to walk
again. But I had to break that down for him to
say, OK, but before you can walk, you have to
sit up by yourself and before that, you have to
be able to stand. He had such severe fractures
to his pelvis and it was so unstable that he
couldn’t put any weight through either of his
legs for six weeks initially. With a fractured
wrist, he essentially had one usable limb.
We started off sitting him up on the
edge of the bed, looking at whether he could
support himself sitting, which he couldn’t, due
to pain and muscle wasting. We had to hoist
him using a hammock into the chair. When
he tried to stand up for the first time using
a frame to weight-bear through his hands, he
said, “That was so shit. I’ve just done so badly.”
I said, “You need to acknowledge that this
is a really big day. You’ve been waiting for
this point for six weeks – you just stood and
swivelled yourself round to a chair.”
Unfortunately, there’s not a lot of dignity
in hospital when you’re using a bedpan as a
28-year-old. He has Asperger’s, so he felt out
of control. He was getting really, really low;
understandably so. I’d say right, today we’re
not going to do active rehab. We’re going to
do something you want to do – watch Netflix
on the iPad, go downstairs to Starbucks.
He is so young. When he had his birthday
in the hospital I ordered him a cake, but
he said, I don’t want a cake. He hated the
hospital food. Luckily, we’ve got the canal
near St Mary’s. So for his birthday we wheeled
him off the ward and he and Giulia got
20 minutes alone, away from nurses, noises
and other patients in the bay. Giulia was only
allowed to visit for an hour each day. It was
really tough on her.
General surgery wards tend to have a quick
turnover, so Danilo would make friends with
someone and then they’d be gone three days
later. He was watching people get discharged
like, “Oh, for God’s sake, I’m still here and
they’re gone.” Towards the end, he was so
fed up with hospital that it really motivated
him to actually get out and get better.
Danilo went home in September. I hear he
is considering going back to work soon and is
walking. It makes your job worthwhile, when
you hear how well they do. nThe documentary series Emergency begins
on Channel 4 on February 28 at 9pm.
Additional reporting: Georgina RobertsS
‘I HAD TO FIX HIS PELVIS AND REATTACH IT TO HIS SPINE’