a vine that can strangle life from a tree...

I’ve never really been particularly sporty. I quite enjoyed playing team sports when I was at school, but there was never any sign of great talent. I wasn’t being picked last for our playground games of football, but I definitely wasn’t being picked first either. Running, however, I loathed. Every week, I think on a Tuesday or Wednesday, we would be sent out on a cross country run. Whatever the weather, we would run three or four miles across muddy fields and along the footpaths out around the school. I say run, but really, as long as I was fairly sure that there was no one looking, I would walk. I absolutely hated slogging my way through the mud and wanted no part of it. It would have been over more quickly if I’d run, but it all just seemed too difficult and too painful. Far better to trudge along miserably in the rain. If I thought I could have got away with hiding in a bush just out of sight, I probably would have done it. The idea that anyone might do this sort of thing for fun just seemed utterly ridiculous. 

Fast forward thirty years, and now it’s the idea that I might have to stop running that really scares me. I sort of fell into running when I stopped playing organised sport and started drinking beer. Popping out once a week for a rather laboured jog was a purely defensive measure designed to stave off an incipient beer belly. 

I didn’t actually start running more seriously until I was diagnosed with multiple sclerosis in 2009. My journey towards that diagnosis began one morning in July 2005, when I woke up with a numb hand. Over the course of the next few weeks, that numbness spread through my body and down through my legs and feet. Running when you can’t really feel your feet is an unnerving experience: you feel with every stride that you might miss your step and break a leg. I thought then that I might have to give up running, but it’s amazing how adaptable the brain is and how quickly you can get used to something that seemed insurmountable. 

As well as a loss of sensation, one of the most common symptoms of MS is fatigue. It sounds counterintuitive, but I discovered that going for a run was incredibly helpful at helping to shake off this fatigue. When you’ve been running, at least you know why you’re tired. Running made me feel better about myself. MS is a chronic illness with no cure and with uncertain outcomes, but running gave me a sense of control. Visiting an MS clinic at the hospital is a sobering experience; to be surrounded by people in wheelchairs, struggling to speak or to swallow is to be confronted by a possible future. I can’t predict or control how my MS might affect me, but I found that to be a powerful motivation to work my body whilst I can. I joined a running group and began to run with other people. I still wasn’t particularly quick, but it’s funny how running with other people makes you run faster than you thought might be possible. 

MS affects everyone differently. In my case, as well as the numbness and pins & needles, I have a loss of strength on my left-hand-side and a loss of dorsiflexion in my left ankle. This didn’t stop me from running, but as I quickly learned as I began to run more often, this changed my gait and made me more susceptible to injury as my body tried to compensate for the loss of strength and power. The further I run, the more I drop my left side and the more susceptible I am to falling over. A sports specialist consultant surgeon told me that I would probably struggle to run much more than 10km and that, although it might not be my MS that stopped me from running, the compromises my body was making probably would. Naturally, I ignored him and kept running. 

In 2015, I ran my first marathon. 

To be honest, the 26.2 miles itself wasn’t my biggest concern: I was worried how my body would hold up to the 500 miles of training and the load of running 5 or 6 times a week. I didn’t set the world on fire, but running side-by-side with my wife, we made it round and raised a pile of cash for the MS Trust (we’ve raised around £40,000 in total, an amount that mainly humbles me because of the support and generosity of our friends). 

Since that day, I’ve run another 5 marathons. At Chester in 2018, I even dipped below the magical 4 hour mark (a 22 minute PB!). I’ve joined an athletics club, picked up my coaching qualifications and taken enormous pride in the achievements of the athletes I coach as they have worked their way from a couch to 5km programme to running competitive cross-country races and half marathons. 

Meanwhile, slowly and remorselessly, my MS has got worse. My legs and left ankle have slowly stiffened; I take a muscle relaxant at night to help me to sleep and I now fall over so often that I run wearing knee pads and wrist guards; my pace has slowed and my shuffling, uneven gait is causing me problems elsewhere in my body (as that specialist predicted). Stopping, you might think, may be the obvious thing to do. 

I’m not going to stop. 

Running is part of who I am. My friends are runners. Running is something that I do together with my wife. It’s vital for my mental wellbeing every bit as much as my physical wellbeing. I’m not just going to stop. 

Sure, I wish I was faster. What runner doesn’t? 

I wish I didn’t fall over so much, but really, what choice do I have? 

Do I want to stop and feel sorry for myself and the things that I’ve lost, or do I want to keep on going as best as I’m able? Is that really even a question? Precisely because it’s become harder for me, I am more aware now than I have ever been of exactly how much running means to me and I cherish every single time I get out. It’s not the falling over that’s the most important thing to consider, it’s the getting back up again. 

I have a tattoo on my weaker left ankle by the Japanese novelist and marathon runner, Haruki Murakami: pain is inevitable, suffering is optional. 

The full quote, from “What I think about when I think about running” is: 

“Pain is inevitable. Suffering is optional. Say you’re running and you think, ‘Man, this hurts, I can’t take it anymore. The ‘hurt’ part is an unavoidable reality, but whether or not you can stand anymore is up to the runner himself.” 

This runner can stand the pain and isn’t done quite yet.

marching on...

Long time readers will likely know a couple of things about me:

1) I like to run

2) I have been very lucky with my MS to be able to continue running.

I try not to take it for granted. I actually only really began taking my running seriously after my diagnosis. I think there was something in my head that made me more determined than ever to stay active. Multiple sclerosis is not something that I can really control; I can't change the way that my legs feel or the other ways that the condition is affecting me, but I do have some degree of control over my own determination to get out and to exercise. 

My first marathon was in 2015, and I've run six in total. My high watermark of this madness was between April 2018 and April 2019. In that time, I ran four marathons. At the beginning of October 2018, I ran the Chester marathon in a time of 3:58... that was a PB of something like 22 minutes. My last marathon was a glorious day spent accompanying my wife to a personal best at the Vienna marathon in April 2019. We got married in the city in 2007 and have some wonderful friends there, so it was a joy from start to finish. I haven't retired from running marathons and half intended to get one booked for 2020, but.... well, lockdown happened.

Actually, more than lockdown happened. MS seems to have taken more of a grip on me over the last few months. Since my symptoms first appeared in 2005, I've always had a certain level of loss of sensation/pins and needles in my legs and feet. It does feel weird to run on legs like that, but it's amazing what the brain gets used to. Over the years, I've increasingly had problems with cramp in my legs. Initially this was in my calves, but it's slowly spread so that I was getting muscle spasms in my thighs. There's also a fair amount of stiffness. I've been accustomed to staggering around a bit like an old man when I've been sitting at my desk for a while, but now this seems to be happening more and more often. After resisting for many years, I now take a very small dose of baclofen (a muscle relaxant) before I go to bed. I may need to start taking a higher dose soon.

I'm falling over a lot more too. The loss of flexibility in my left ankle and strength in my left side has always made me a bit prone to this. I drop my left side as I get tired and start scuffing my left foot, which leads to stumbles. This is happening more and more often, meaning that I now go out running wearing knee and wrist guards (my knees have taken a frightful pounding from this and are now sore most of the time). 

I could stop running, but I don't want to. In fact, although I might be running more slowly at the moment, I'm actually doing more miles in lockdown than I think I've ever done before. I managed about 1220 miles in 2019 and I've done 1382 so far this year with 7 weeks still to go. I'll probably go comfortably over 1500 miles for the year. I'm still capable of running more quickly, but my default pace now seems to be a rather sorry plod because I don't really trust my legs any more.

I'm not telling you any of this looking for sympathy. It's just that I'm starting to acknowledge something that I've tried to ignore for more than a decade now: my MS is progressing. The official shift in my diagnosis from relapsing-remitting to secondary progressive a few weeks ago was recognition of that simple fact.

My own sense of self and wellbeing is bound up in my ability to run. For better or for worse. I'm going to keep running. Of course I'm going to keep running. I'm just slowly starting the process of coming to terms with the fact that I'm not bulletproof and that I can't control the progress of this godawful condition.

 You adapt, though. What other choice do you have? I'll always have that 3:58 marathon, eh?

don't stop moving...

As they're obviously trying to keep (potentially vulnerable) people away from the clinic at QMC at the moment, I had my annual consultation with my neurologist over the phone today. Actually, it was a surprisingly effective way of doing it and was probably as helpful as any of the sessions I've had at clinic since I first started getting symptoms. 

The long and the short of it is that my disability has been slowly increasing over the last few months/years and today they've shifted my diagnosis from 'relapsing-remitting' MS to 'secondary progressive' MS. 

I think this sounds more significant than it is. Ultimately, it's just a label to describe the way my disease is progressing. Most people with MS have a series of relapses, each relapse bringing new symptoms and new problems which get a bit easier with time (without ever completely disappearing), before the next relapse arrives and starts the cycle again. Almost all the treaments for MS are designed try and slow down the frequency with which you have relapses, thus slowing the progress of the disease and increasing disability. There isn't a cure. 

I've never really had relapses and have just seen a slow, but steady increase in the severity of my existing symptoms. I haven't been on a disease modifying therapy for a couple of years now, so shifting my diagnosis is really only an acknowledgement of the way my MS seems to be progressing: I'm not expecting relapses, but I am expecting my legs to get stiffer (amongst other things). The shift closes the door to lots of treatment options, but may open the door to others. 

It's only a label... but at the same time, it can't help but feel like a significant moment. It sounds significant. 

Still, I have much to be thankful for: we're off on an 11 mile run tomorrow morning and I've run a little over 1,100 miles so far this year. Very little of that has been as fast as I would like, but I know that I'm still capable of running quickly when I really want to, and I was only a few seconds off my mile PB a few weeks ago. Whilst I now don't trust my legs to the extent that I won't go out without knee pads and wrist guards, running remains at least as important to me now as it ever has done and I cherish what I can still do. 

Every run, no matter how long or how fast, still feels like sticking two fingers up at this diease. Long may it continue.

be brave...

For as long as I can remember, I’ve been called cynical. Cynical, negative and pessimistic. For a time, I was called it so often that I almost believed it myself and began to build my sense of self around it. 

The cynic. 

To be honest, I’m not sure that this has ever really been the case. It certainly is true that, as a younger man, I would throw stones and would criticise without feeling the need to offer up anything constructive. I’m pretty sure I’m not alone in going through that phase. It’s also true that, when feeling frustrated or powerless at work (annoyingly often), I would sometimes deliberately seek to tear people down in a way that was ultimately self-destructive…. But I was young and stupid and I don’t work there anymore (which is probably just as well: some people choose never to forget the person you were fifteen years ago, even if you’ve long since changed). 

I think it probably boils down to this: I like to ask questions. These days, it’s usually to genuinely try to understand something because I’m curious. The problem is that lots of people don’t like to be asked questions; they don’t like to be challenged by someone because, if you don’t know the answers or you aren’t very secure in your opinion, it can feel as though you’re being criticised. No one likes to be criticised, right? I try not to be threatening about it, but nobody’s perfect and I’m probably not the finished article even now. 

I think my MS has changed me, actually. Or maybe it’s just revealed another side to my personality. Nobody knows what causes MS, nobody knows if it will progress for me or what my outcome will be. There’s very little that I can do to change any of these things. I’m not really one for serenity prayers, but I do think that this has taught me acceptance. To paraphrase Kipling, to meet with Triumph and Disaster and to treat those two imposters just the same. I’m calmer, more relaxed and better able to approach life on an even-keel (whilst also remaining perfectly capable of frothing in indignation watching the news. Nobody is perfect. My wife is doubtless scoffing as she reads this). 

What’s the point in being pessimistic? I’m well aware what MS might do to me and I know all too well what it’s already done. I simply don’t see how dwelling on either of those things does me any good at all. MS pages on Facebook seem full of people wrapped up in their own invisible pain and suffering. I don’t doubt that they suffer, but I simply don’t understand the attitude because I try never to allow myself to think like that. Perhaps that’s easy for me to say, but I hope it’s a philosophy that will stay with me, whatever happens. “The Road not Taken” by Robert Frost is one of my favourite poems; my interpretation of it is that you should never waste time regretting the path you didn’t take. 

They say that a pessimist is never disappointed. I think they’re always disappointed. Besides, I’m a runner, and as Kipling also said:

If you can fill the unforgiving minute 
With sixty seconds’ worth of distance run, 
Yours is the Earth and everything that’s in it, 
And—which is more—you’ll be a Man, my son! 

Well, I can definitely do that. Maybe not as fast as I use to be able to do it… but I can still do it.

if I surround myself with positive things...

It was World MS Day on Saturday.

I woke up at about 03:30 to find my whole lower body in spasm. from the muscles of my lower stomach down through my legs to my feet. I've been getting cramps in my legs for some time, but this is different, it's not a sudden clenching of the muscles but something that lasts for longer. It's not as intensely painful, but it is uncomfortable and has a halo effect that lingers in the muscles for some hours afterwards, as a deep-set stiffness in the muscles.

As I often do when this happens, I got up and walked very stiffly to the bathroom. This is partly to ease the muscles off, but also I'm now pretty entrenched in the habit of emptying my unreliable bladder when it is convenient. I catheterise myself every night before bed to ensure I sleep with a completely empty bladder and take a drug every day to help resist bladder urge, but as I was awake it was a way to kill two birds with one stone. It was already pretty light outside and the dawn chorus was really starting to get underway. It was really quite a lovely.

That done, I staggered back to the bedroom to try to get some more sleep, popping an ibuprofen along the way in the hopes of waking up with a bit less muscle pain.

This is my new routine.

We already know that the problems with my bladder are related to my MS: my brain isn't able to reliably empty my bladder completely, and I will often get the urge to pee even if I've only just been, whether my bladder is empty or not. It's likely that the muscle spasms in my lower body are MS-related too. There are drugs you can take to chemically relax these muscles and to try and get a good night's sleep, but I'm reluctant to take them. 

After all, I'm a runner.

Running keeps me sane. This was true before the lockdown, and it's doubly true now. My ability to get out of the house and clear my head on a run is precious to me. I'm probably getting slower as I get older, but the speed I run is not nearly as important to me as my ability to run at all. As things stand, I don't want to compromise the ability of my legs to carry me and so, if the spasms are the price I need to pay if I want to keep running... well, then it's a cost I'm prepared to pay.

Mind you, I have been doing quite a lot of running recently: I covered 145 miles in May, almost all of it side-by-side with my wife, who hasn't run as far in a month, even when she was training for her marathons. Quite a lot of this mileage has been slow, on stiff legs. Where the speed of my wife used to be our limiting factor, these days, it's more likely that she's waiting for me. It's not that I can't run fast any more - I'm doing at least one set of intervals a week where I try to let the brakes off - it's just that I'm really just happy to be moving at all; delighted just to get out of the house in this beautiful weather and to enjoy the fresh air and the flourishing spring around us.

On Saturday, after another couple of hours of sleep, I got up and went out for a 5km run. It wasn't fast and it wasn't pretty, but I like to think that it helped to stretch some of that stiffness out of my legs. Maybe, maybe not. Either way, it definitely made me feel better.

I was diagnosed with MS in 2009 after 4 years of symptoms. It's an incurable condition with uncertain outcomes, so it's a frightening thing to be labelled with. Maybe I'm one of the lucky ones, but I do firmly believe that MS only has as much control of your life as you allow it.

As this film from World MS day a few years ago shows beautifully, a diagnosis with multiple sclerosis does not have to mean the end. Life is what you make of it, and other cliches.



I think I'm much stronger and kinder now than I was in 2009, and I thank MS for that.

like a lead leaf scrapes the gravelled ground...

It feels as though a lot has happened since my last post at the end of February. How can it even be possible to write a catch-up post that encompasses everything that happened during the course of the longest month since time began?

I don't think I'm even going to try.

Suffice it to say that the big news around here is that I've finally shifted across to a mesh wifi system. I've been meaning to do so for some time because, although my broadband is fibre optic and in theory very fast, in practice it's handicapped by constantly dropping wireless signal and the need for endless router reboots. Well, those issues are firmly in the past, let me tell you.

... Oh, there's something else?

As the New Yorker so elegantly put it in their cartoon today:

A brief montage of my March, then: we went to Austria and had a lovely week skiing that became a bit weird when it became clear that everything was going to be locked down and things started to close. We made it home on the last day they were operating flights from Salzburg, and we've been in lockdown here pretty much ever since.  Luckily for me, the new job that I started at the beginning of March is home based, so I'm obviously well-equipped to remote work. I miss my running clubs and I'm not uploading sessions for the group I coach onto WhatsApp, but the fact that I can still go outside for a run once a day makes all the difference to the way I feel. If I couldn't run, I don't know what I'd do.

Isn't it weird watching how people come to terms with the restrictions and how, as a society, we seem to have moved from panic buying toilet roll and pasta to loudly judging other people for how well (or otherwise) they're sticking to what they perceive to be the appropriate social distancing guidelines/rules from the government and assessing how well other people understand the concept of 2m of social distancing.

I also can't be the only one to feel slightly uneasy about our slide into "hero" culture for those people who work in the NHS or for other critical services. It's lovely to hear people coming out at 8pm on a Thursday night to applaud these "heroes", but at the same time, the best way to recognise these people is to pay them properly and to make sure they have the right equipment, isn't it? The Health Secretary may wear an NHS pin badge on his lapel, but he is part of a party that has systematically starved the health service of the money it needs to run effectively.  Let's hope people remember that when this is all over and we're next at the ballot box. And don't get me started on that tool from Wetherspoons. As for the clapping itself, I'm reminded of the mentality that some people have towards the armed forces, as skewered by Larry David in Curb Your Enthusiasm.

Strange times.

On a positive note, I think the MS charities have been doing an amazing job trying to keep people with multiple sclerosis up to date on the latest thinking on how the virus might affect us. It's all very well to try and reassure people that many of those people dying are old or have an underlying condition, but that's of little comfort if you are old or do have an underlying condition. It's a strange feeling to think that, if I were to catch coronavirus and die, someone would shrug and say, "Yeah, well he had MS, so.....".

Here's a really interesting post on shift.ms about how suffering from a chronic health condition like MS actually prepares you well for this world of social isolation. 

"Compared to the rest of the population, we are all used to:

- Being stuck in limbo, nobody can ever tell us how long something will last and if it will be permanent, temporary, relapsing remitting or progressive.

- Living with uncertainty. We all know only too well that nobody can predict what the future holds for us and that we have to plan as best we can, but always live in the present."

Well worth a read.

Stay safe. We're living in interesting times.

Danger! High Voltage!

I had a consultation with the neuro-rehabilitation unit at a local hospital towards the end of last year. I was seen by a specialist registrar, senior neuro-physiotherapist and a senior orthotist. Quite the collection of experts. They've just copied me in on the report.

Two things caught my eye:

1) "On examination, this gentleman is tall at 6' 5"" -- note how many experts it took to notice this particular detail.

2) "We believe that running marathons and training to run the marathons might exacerbate some of his symptoms." -- Oh dear. Luckily, they weren't finished there -- "Therefore, our physiotherapist advised him to alternate different modes of exercise between running marathons".

This isn't really news to me. At least they're not daft enough to suggest that I stop running altogether.

I always used to swim a couple of times a week, but when I started running marathons in 2015, everything else kind of fell by the wayside. I've also done a particularly large amount of long mileage runs over the last 18 months as I completed 4 marathons between April 2018 and April 2019. That would probably put a strain on anyone's body, never mind one with bio-mechanical issues brought on my a loss of strength on one side.

Since the Vienna marathon in April last year, my monthly mileage has actually probably gone up a bit. Two other things have changed though: I'm not doing the really long training runs you need in order to train for a marathon; I"m also running a lot of my miles more slowly, either with the group that I coach, or with my wife. This is reducing the amount of strain I"m putting on my body.

I'm not saying that I'm never going to run another marathon. After dipping under 4 hours at Chester in 2018 it's true that my desire to run 26.2 miles faster has all but disappeared. Am I interested in putting in the work to shave a few minutes off that time? Not really. 3.45 doesn't sound much better than 3.58 to me. Especially when you consider how much work would go into finding that extra few minutes. So, I'm not interested in going faster, but I am perhaps still interested in running a marathon with my wife again.... Vienna in April 2019 was a joy from start to finish. I don't have anything planned this year, but I am doing a 15.6 mile trail race tomorrow at Belvoir, so we'll see.

One other output from that consultation with the neuro-rehabilitation unit in November was an appointment with the FES team in Derby, which I attended this week. For an hour or so, I had a device attached to my left leg that fires electric pulses down the leg to stimulate the flex in my ankle. It feels a bit like a TENS machine (if you remember them), and it looks like I might be able to borrow a unit for 6 weeks or so to see if it makes any difference to my running. In all honesty, this kind of device is generally used to help people who are essentially immobile to walk again, so it feels a bit gratuitous to strap it onto someone who is still capable of running a marathon... but we'll see. They seem interested to find out how it helps a runner. Watch this space.

223 miles of running so far this year with another 15 or so to come tomorrow before February is out. I ain't doing so bad.

you are the unforecasted storm...

As an addendum to the post below, I received a letter the other day from the neurologist. Apparently, my November 2019 MRI scan shows no evidence of new disease activity.

This is clearly excellent news.

From the very beginning, my MS hasn't seemed to follow the usual patterns. Although I have technically been diagnosed with relapsing-remitting multiple sclerosis, where patterns of disease activity are followed by periods of remission and partial recovery, my MS has always behaved a bit differently. Most of my initial symptoms can be traced to a single lesion in my cervical spinal cord, but I haven't had a clear relapse since that first one and I don't seem to have developed any new lesions (the scarring on the brain or spinal cord left by the inflammation). That said, although I haven't developed any radically new symptoms, I have seen a general (albeit fluctuating) worsening of the ones that I do have. Relatively speaking, compared to others, I'm doing great... but the disease has changed my life. As well as the muscular symptoms of weakness, numbness and pins & needles, I also now take a pill to manage bladder urge and self-cathertise every night to ensure that my bladder is completely empty before I go to bed (I'm also careful of the volume of what I drink after about 20:30 at night. No more last orders at the bar for me). These things are different from what they were when I first developed symptoms in 2005. I may not have visible signs of disease activity in my MRI scan, but you can now see them in the way that I walk.

I think what this shows us is how complex a condition multiple sclerosis is; how it's an umbrella term for a massively varying set of symptoms and presentations. It's a handy label to put on people, but every single person seems to experience the disease differently. It's amazing how much the doctors and specialists do know, but equally very clear how much they don't know too.

I'm doing well. There's no sign of new disease activity in spite of the fact that I've now been off all medications relating to my MS for a couple of years now. It was a risk to stop injecting the drug that may (or may not) have been slowing my disease progression, but for the time being, it seems to be a risk that has paid off.

Long may it continue.

In the 43 days of 2020 so far, I've run 155 miles. I don't have much to complain about.

we are standing on the edge...

Sometimes I wonder how much I let MS define my life. I see memes on various Facebook MS groups that talk of no one understanding their world of invisible pain, and I just don't relate to them at all. I appreciate that different people process things in different ways, but I've always thought that I'm exactly the kind of person who doesn't wallow in the fact that I have multiple sclerosis.

But is that true? Can it be true?

Taking only this morning, I've worried about whether or not I'm finding it harder to sleep at the moment, I've thought about my bladder and bowel function, I've wondered if my bad back is being caused by any of the pills I take, I've staggered around on stiff, cramping legs and dragged a stiff ankle up and down the stairs a couple of times, I'm typing right now with numb hands. Is it really true to say that I'm not letting my MS define me? Just because I'm not posting memes about it?

Probably, some of these things will have nothing to do with my MS. A few definitely are, but I have to remind myself again that I'm actually extremely fortunate with my MS: my symptoms are reasonably stable and all of the above has to be taken in the context of the fact that I'm planning to go out for a 5 mile run this evening and that I've run 145 miles so far this year. Alright, so I'm finding running a bit harder at the moment, but it's not as though I'm doing much less of it.

I try not to put every little thing I feel down to my MS, but it is inevitably a filter through which I view the world.

Maybe that's the most insidious symptom of them all.

I'll be needing stitches...

I had a busy day last Wednesday. I think it's fair to say that, since redundancy, my days haven't seemed quite as busy as when I was working 11 or 12 hour days every day.... but last Wednesday was definitely a busier day than average: a hospital appointment first thing, an appointment to take one of my MyGuide clients out for a walk at lunchtime, an interview with the charity that are looking to appoint me as a trustee and then the second week of the short course on creative writing that I'm taking at Nottingham Trent University.  By the time I got home at around 9pm, I was very much looking forward to sitting down with my tea and watching a bit of disposable telly.

At about half ten, I popped upstairs during an advert break (we were watching Elementary on Sky+. so we could have just skipped forward, but I needed to grab something from the bedside table). As I rounded the top end of the bed, I was unscrewing the lid on my drinks bottle when I was suddenly falling. I think my legs gave way, but as my hands were busy, I didn't have any time to react to this before my knees hit the ground and my chin hit the bedside table.

There was a short pause as I gathered myself and did a quick mental inventory: what just happened? have I really hurt myself? I was naturally a bit dazed, and my immediate reaction was to feel my teeth to see if I'd knocked any of them out in the fall. They seemed okay, but my ears were really hurting for some reason. At this point, I realised there was blood coming from somewhere, so I headed to the bathroom mirror to assess the damage. Through the beard on my chin, I could see a gaping cut. It wasn't more than an inch or so across, and it wasn't pumping blood, but it looked pretty deep.

Balls.

By now, my wife had rushed up the stairs to see what all the noise was about, and together we applied pressure to the cut and tried to work out what we needed to do next. It was tempting to do nothing and to just try and cover up the cut and go to bed, but I'd had a pretty nasty bang and the cut looked pretty deep, so we settled on calling 111, the NHS urgent care hotline. The operator on the other end of the line methodically ran me through the concussion protocols and then tried to assess the cut. I was coherent and seemed to be okay, but we agreed that the cut likely needed stitches and I probably needed to an x-ray. They passed my case on to the A&E department at QMC and told us to get there within the next hour.  It was a pretty efficient process and this call effectively acted as the triage for the hospital, and once we got there, all we had to do was to wait our turn. But there's the rub: we got there at about 23:30, and the screens were showing an 8.5 hour wait.

So we waited.

On my way back from my class, I'd wandered through town at about 20:30 and marvelled at the packs of students in fancy dress marauding through the city on their way down to Ocean. They were quite the spectacle, many wearing nothing more than a pair of speedos, and most of them being extraordinarily drunk for such a relatively early hour. As things worked out, I now saw several of the same people at the other end of the day, arriving at A&E covered in blood. Not a great way to end the evening, but most of them seemed in good spirits. Literally, I guess.

The staff were brilliant.There just weren't enough of them. One doctor and maybe three nurses for the whole department (there was another doctor, but he was called away). What made things worse was that several of the people waiting were clearly suffering from various mental health issues and were there because they simply didn't have anywhere else to go. It's heartbreaking to watch people sitting there with problems that an accident and emergency ward is never going to be able to fix. The staff are amazing, but they can't work miracles and they've been handicapped by a decade of austerity.

By the time we got actually seen by the doctor at about 6am, I was staggered by how cheerful he was, and how, even 11 hours into his shift, he was still looking for blankets to give to some of the shivering students. I was examined, X-rayed and stitched up. The A&E doctor thought he saw a fracture, so I was referred up to the Head and Neck ward, which was just opening up for further consultation. The consultant there explained to me that he was fairly sure that I didn't have a fracture, but because the A&E doctor had documented one, they needed to be super careful to rule it out. Did I mind waiting for a CT scan? Ah, what the hell. What's another couple of hours when you've already been there for ten?

So we waited. We had enough time to get a coffee and something to eat, but then it was the scan and a final consultation to hear the news that I almost definitely didn't have a fracture. They were worried about what's called a "Guard fracture", apparently: named after what happens when a sentry faints at his post and lands directly on his chin, causing fractures on the point of the chin and on the hinge of the mandible on either side (which is why the ears hurt).  I left the hospital with a sore jaw and a couple of stitches, but the feeling that I'd been really very lucky indeed not to have anything worse. A fracture might easily have involved extensive surgery and pinning.

It was a very, very long day.

The thing that I really don't want to think about is *why* my legs gave way. I think we probably know why, don't we? I've an underlying weakness in my legs, especially my left leg, that has been getting worse and worse recently. I've been moaning for a few months now how much harder running seems at the moment. I guess this is another thing that can happen. 

Understandably, I don't really want to dwell on this. I appreciate that something like this can cause as many mental problems as physical, but I really don't want to live my life like that. Maybe it's excessively stoical of me, but who wants to live their life like that?

Mad props to my wife for helping to pick me up and then spending a long, uncomfortable night at the hospital before heading off to work once we got home. I just went to bed, but she's hardcore.