The World I Fell Out Of
Author: Melanie Reid

Background

This first hand account of one of the worst possible human tragedies is a most touching story of profound loss presented in exceptionally elegant prose. With an almost dispassionate narrative, the author bravely recounts her experience of spinal cord injury in which she explores the capricious emotions that accompanied it, and the profound lessons it taught her. Writing almost contemporaneously because she wanted to re-establish some control and ‘escape from emotional anguish‘, she found the narrative to be ‘a way of processing the trauma‘ of losing crucial physical and vegetative abilities, and the loss of independent function. Replete with humour and reflective insights, the book is also a lesson in the philosophical constructs that mitigate the impact of devastating loss. It is also a helpful study in human nature documenting, as it does, the best and the worst of those who care for the disabled (pages 19 and 205).

Synopsis

The author related the fateful event that totally changed her life with admirable lucidity and detail. She portrayed how she fell off her horse on an ordinary day, one minute being ‘blissfully ignorant and complacent‘, and the next ‘pinned to the ground with a broken neck and fractured low back‘. The pain she had was like ‘a blinding red flash‘ and ‘a most beautiful, intense feeling of warmth‘ which she portrayed as ‘my own internal nuclear explosion; my own terrible mushroom cloud‘. Her depiction of the result of the catastrophe, bitter and mournful, was of becoming ‘a doubly-incontinent tetraplegic‘ who required her diaphragm to breath. She symbolised the inability to feel anything below her neck as ‘the one-way sensation of touching my own warm skin, and feeling nothing back‘, and the loss of movement as ‘four-fifths of my body has divorced me, but it’s still attached to me’. She also graphically described the inner sensory torment of feeling as if ants were ‘devouring me from within’, and of being ‘inwardly consumed by chemical distress and bewilderment‘. Her loss of the ability to walk was particularly galling because prior to her accident, she considered her legs as her ‘closest allies‘, and her six-foot height as a foundation of her ‘identity‘. She was also frustrated by the loss of autonomy that her disability entailed, a situation that meant her ‘comfort was outsourced‘ to others (pages xiii, 1, 14, 23-24, 30-31 and 75).

The author’s reflections on the panoply of the emotions she went through conveyed how the psychological impact of spinal cord injury matches the physical. Her reminiscences, for example, expressed the feeling of bitterness around the ‘everyday, non-earth-shattering mundanity’ of the accident; the annoyance for causing ‘all this fuss’ to her rescuers; the ‘kernel of grief which nestles at the centre of my being’ that she did this to her family; and the ‘feeling of almost unbearable loneliness…that I was absolutely on my own in this’. She also conveyed the feeling of depression on realising the things she was no longer able to do; the violent overwhelming grief, self-pity, and profound ‘sense of dislocation and loss‘ when reminded of her healthy past, or her current disability; and the melancholy that fills her because of ‘my inability to fulfil my roles’. She also provided an insight into the burden of trying to hide her emotions from family and friends just so that she may conform to the expected stereotype of putting up a brave face and not alienating them. She however also experienced positive emotions such as when said that ‘hope has never left me, but it coexists with acceptance‘, pointing out that although ‘life may be smaller‘, it is also ‘immeasurably good‘ (pages 2, 5-6, 28, 68-69, 189, 196 and 359).

The author’s experience of rehabilitation constituted a major part of the book, and she reserved her darkest humour to describing this phase of her illness. For example, she compared her arrival at the rehabilitation ward to a spaceship landing her on ‘yet another alien planet‘, where she learnt to get used to ‘a relentless timetable of feeding, medicating, washing, toileting, dressing, and hoisting dozens of helpless carcasses into wheelchairs’ – the aim of which was ‘to get us wrecks into the best possible state of semi-independence as quickly as possible’. She facetiously described rehabilitation as ‘trying to ride that ghastly non-compliant new horse which was my body, and as ‘a terrible physical challenge that bucked and threw me contemptuously, time and time and time again’. She however also saw it as ‘the psychological process of learning my limitations in an able-bodied world’ and as ‘finding a different role to the one I had before’. The limitations of rehabilitation were however exasperating, and she illustrated this when she said ‘all around me I saw things that needed to be done…and I could do none of them. I could only look. It was a very real torture‘. She further brilliantly captured the restrictions of home life when she noted that ‘I could not get up, dress or wash myself, nor, at night, could I lift my lower legs onto the bed’. She also conveyed the sense of how her ‘navigable space‘ became bounded, making her to behave ‘like a wounded animal‘ with a ‘lair mentality‘ who ‘existed in the rooms of the house which I could navigate‘ (pages 43-44, 66 and 179-184).

The authors reflections on the human interactions on the spinal ward were most insightful as they symbolised the compassion that makes tragedy tolerable, and the callousness that makes it unbearable. In this regard the author extolled the nurses who, despite their work being ‘noisy, shitty, relentless‘, supported and comforted her beyond the call of their duties. Bridget, for example, provided her with the positive words which she grasped as a lifeline, and which ‘strung themselves into a banner in my head’, whilst Christine’s words were ‘a rope to the shores‘, which ‘held me, steadied me‘. Gillian on the other hand was ‘perceptive, giving, hard-working, modest to the point of shyness’, who was ‘a great hugger’ and was ‘largely responsible for holding me together mentally’. The author particularly extolled the auxiliary staff as ‘the biggest-hearted people…both in time and emotional warmth‘, and she illustrated this with the examples of Marigold – an exuberant friendly single mother with a loud voice and a huge heart, who often sang to us and hugged us generously when she saw we were miserable’.  Whilst most of the ward staff treated her with extraordinary kindness and ‘connection‘, she described some as ‘disengaged‘ and ‘impersonal‘, and a few as exceptionally insensitive; an example of the latter was Nettles – thoughtless, ‘hard and cold and unkind‘, and whose ‘body language was contemptuous‘ (pages 42-44, 9, 13, 80, 82, 85 and 78).

Throughout the book the author recorded her somber introspections and philosophical reflections about all aspects of injury and loss. Some of the author’s most insightful thoughts were on the changes imposed on her social circumstances by her injury, and she captured this most imaginatively when she referred to the world she fell out of – ‘the upper world’ of the healthy and the able-bodied – and the world she fell into, a ‘parallel existence …just below the surface… where all the people you never think about live – the sick, the halt, the lame, the chronically ill and the elderly‘. She contemplated on how, ‘in an instant, one tribe cast me out and I was forced to join another, a hidden army of people fighting their private battles against ill health, simply trying to keep going the best they could’. Whilst her earlier ruminations were mainly self-pitying – of the ‘why me‘ type – she was later able to put things in perspective, realising that ‘things could be worse‘, and that ‘in the grand scheme of things‘ she was lucky. Indeed she went on to ponder over the lessons of her experience, such as how ‘long-term incarceration in hospital teaches you tolerance, patience, and the knowledge that we are all very, very human‘, and on how ‘disability has taught me to celebrate life and possibility‘. Based on these, she advised people to ‘focus on what constitutes your life at the time and love what you already have’; to ‘choose to find happiness, whatever our circumstances’; to ‘pause and appreciate exactly what you have’; to ‘cherish the people you have’; to ‘follow your dreams‘; and to realise that ‘stuff which you think matter‘ do not (pages 76, 106-109, 74, 263, 357, 368, and 171).

Opinion

With some of the best prose of any illness narrative, this book is a detailed and humorous portrayal of a devastatingly cruel neurological injury. The author accurately captures the emotional impact and the physical limitations of losing control of the body. The book is as much a depiction of the victims of inauspicious circumstances, as it is a critical assessment of those who care for them. With honest and insightful reflections, the author admits to uncomfortable truths about her condition, and the ways she had coped. Her level-headed approach to the subject however went a long way to lighten the grimness of the theme of spinal cord injury, and this enabled her to extract discerning life lessons from it. The book is also a lesson in appreciating life, recognising its tendency to suddenly change, and living it to the fullest at all times.

Overall assessment

Spinal cord injury is devastating, and this book delves into the life of one of its most insightful victims. The book is a masterclass in how to understand the perspective of those who suffer all types catastrophic injuries, and how to cater for their inestimable physical and emotional requirements. The author’s depiction of the management of spinal cord injury is also revealing especially about the value of empathetic and selfless carers. All the themes the book explores are generalisable to all of healthcare, and I recommend it to all doctors

Book details

Publisher, Place, Year:  4th Estate, London, 2019
Number of chapters: 15
Number of pages: 383
ISBN: 978-0-00-829137-2
Star rating: 5
Price: £8.19