2 Years on and I’m finally playing Magic in Rocklands again. Photo by Jethro Watson
This post, will be the last in the continuous timeline, my recent update briefly details how I’ll be writing after this post. The post recounts some of the events and feelings of the last 4 weeks of rehab. It was busy and challenging and I applied myself fully to the process of rehab. There was however a disconnect, as my body was healing and deriving meaning from that, my mind was consumed by grief and sadness. As a disclaimer, this is a dark post, if you’re not in a space to deal with that then read it later. It is what I felt at the time and although I know a part of me feels that same sentiment now, it is definitely not the wolf that I fed. I recall Jordan Peterson saying something like its not that the world is any less chaotic and terrible than you imagine, it may even be worse, its that you as an individual are strong enough to actually contend with that. We as humans are strong enough, and its important that we use that strength. Each and every one of our journeys matter.
Monday saw a return to the productive routine of rehab. I had an hour with the physio and an hour with the occupational therapist. It felt good to do some exercise again after the emotional weekend and I stayed in the gym after the guided sessions were over. I opted for a 30 min cardio session to try to work out some frustration. It helped whilst I was doing it but my energy ran out. When I stopped I was confronted by the view of Devil’s Peak out the window. Looming large and imposing near the rehab facility, it felt as if the mountain was mocking me, “Looks like you were enjoying life, well here’s some suffering for you”.
The rest of the second week in rehab continued much the same. I actually hopped with the walking frame from bed A to bed B. I stood in the parallel bars and took one hand off, one of the most terrifying things I’ve ever done. But overall and despite the enthusiasm of the first week, the week was tedious. The loss of the old me ever-present. When asked about the sense of loss I felt by the rehab counselor I was reminded of the loss I felt when my first relationship failed and when my good friend Schalk committed suicide. I was devastated but continued on. The lessons learnt from experiencing prior loss were useful but the loss remained. Cold, hard and final. The climber I once was, was dead. And like Tolkien’s elves would forever experience the the grief of their kinslaying, so would I carry that loss with me, always.
The wounds healing well underneath the Taylor Space Frame. Photo by Jethro Watson
On the more physical front, the left knee had started loosening up after being fixed straight for 8 weeks. I was becoming aware of the increasing movement and instability in the knee. It felt as if the knee was separating everytime I moved it and the lower leg was scarcely attached. It was also clicking and grinding, loud structural noises which the Physio was concerned about. Dr Laubser visited me and said that there was almost certainly further damage to the soft tissue (muscles, tendons, ligaments, etc) but that there was nothing we could do until the bone had healed. He made clear the importance of weight bearing on the broken bone. Without stimulus the bone would not heal. Once the bone was healed and the TSF removed, I could go for an MRI to assess the soft tissue damage.
The rehab professionals had now had enough time to assess my condition and held a family meeting to outline the process. I would be in rehab until the 4th of October, 6 weeks in total. To help prepare me for integration into the world beyond hospital they would send me ‘home’, first for a few hours, then a day and finally for a night before being fully discharged. That weekend I would be going to my parents house (since my home in the mountains was no more) and would see my dogs for the first time since the accident. My dogs were with me when it happened and Luthien sat right next to me until the paramedics arrived. How much they understood about the situation is debatable but they knew something terrible had happened. Judging by the reaction I’m certain that they thought me dead.
I cannot even begin to describe the feeling… Photo by Colleen Watson
Each week in rehab was harder than the previous. The relentless regime of exercise and learning how to function in the new world was taking its toll. By the end of each day, the inflammation and pain had reached its crescendo. The exercise, moving around and adjustments to the TSF pushed the pain beyond the reach of the drugs. The phantom pain which wasn’t being blocked by the opioid painkillers was also mounting and was at times the worst pain I experienced. Each day at around 5pm I would be back in bed holding on to my sanity as the pain consumed me. Adding to this was a sense of tiredness which I had never before experienced. The tiredness was a state of living death, at times I was sure I was on the ‘other side’ looking in at life.
There was however an event which saved me from full detachment. When my sister had bought me Magic cards from the Luckshack the Lady who helped her took an interest in my story. She and the community there arranged a visit to the rehab by three wizards, Jay, Dilyn and Daniel. For the afternoon we played Magic: The Gathering. It was so good to cast spells again and take my mind off the tedium, pain and loss. I cannot express how important that gathering was. It was perhaps the first glimmer of real hope that I may be able to overcome the suffering which was all too apparent.
Thanks Luckshack and the wizards, this really was hope unlooked for. Photo by Dilyn
I would be discharged for the full sunday and would eat my first proper meal outside hospital. My mother and I would also brave the world to go to a mall and buy a vinyl player to play the Tool LP which I had bought as a form of retail therapy. Overall It was a good weekend and the magic had been such a god-send, but as the flourescent lights of the hospital rehab welcomed me back I could not escape the pain and the loss. All I wanted was to go back through the looking glass, back to my tent in the Cederberg, back to the strong energetic climber cuddled up in his bed with his dogs, back to the life I had dared dream and tenaciously created. Some feelings cannot be expressed, they can only be felt, and it was too much. Not for the last time would I think that it would have been better to have died on that mountain, to check out before the suffering that followed.
Transferring from a wheelchair into a car for the first time. Photo by unknown
The last two weeks of rehab were a grind. Everyday doing as much exercise as my body could manage before the pain and tiredness hunted me down. The phantom pain in the amputated right leg was so severe that the doctor had put me onto a specific antidepressant that was known to have an effect on phantom pain. That combined with a higher dose of Lyrica, a drug originally for epilepsy but commonly used for nerve pain. The effect was roughly the same level of pain and a sense of lethargy and acute tiredness. The physical strength was increasing but I was drawn thin.
The end of the hospital stay had become my focus. No more 5am coffee, constant activity or fluorescent lights. An event horizon beyond which there was nothing perceivable. On the final weekend of rehab I would spend my first night out of hospital in weeks untold. Although the pain kept sleep patchy, it was still the best sleep Id had since the last night in my tent. It did nothing to alleviate the tiredness however. The next day I showered, it took almost 2 hours but I could actually achieve the task. I had been able to build enough strength and skill in 6 weeks of rehab to be able to exist outside of hospital.
Signing out of rehab on the last day. Liberating and terrifying. Photo by unknown
I would make it out of hospital in the end. Something that at one stage wasn’t necessarily clear. What world awaited me I did not know. Even the sun looked different out the windows of the car on the way to my parents house. I was broken, in pain and tired, so fucking tired. After 12 weeks in hospital I was spent, but I had made it. I knew that the journey must continue but for now I just hoped to rest.
It was a fool’s hope. The light at the end of the tunnel was the end of the hospital stay. Without that light, the world was dark. Sleep would elude me still that first night, afraid of the dark as I was. My legs buzzing and burning as I lay there, the cage of the external fixator amplifying any movement into pain. The grief and loss consuming my mind. Would it not have been better to have just died there, on that mountain, to not have all this suffering.
Like a cairn marks the way in the mountains, moving to the rehab centre marked the way on the path back to the mountains. It was the first time since the accident that I would feel something akin to positivity after a long and exhausting fight through the gauntlet of surgeries. Photo by JM Watson
A Change Has Come
I transferred to the Life Rehab centre across the road from the Vincent Pallotti hospital for my post surgery rehabilitation. They just wheeled me across in the same hospital bed. It was the first time I had felt the sun on my skin for almost 7 weeks. Rehab was like a hospital in that we were in hospital beds in wards of 6 beds each. There were nurses and the same fluorescent lights. It was also unlike hospital, there was a canteen and a gym and patients were moving around freely, no longer confined to their beds. What a change.
On my arrival I met the physio, Madiga. She explained roughly how the setup works. I would sleep in the ward but would be doing guided gym sessions with her and an occupational therapist. They would get me into a wheelchair of my own. I would also be able to go to the canteen to eat meals. When she first saw me she asked why I was still in bed, I knew then that rehab had a different approach than that of the hospital. Instead of rest and recover, this was a place of action. Immediately I embraced that.
I didn’t have any physio that day, but I was able to use a kommode for the first time (basically a wheelchair with a hole in it to shit through). I cannot tell you how relieving it was to be able the sit on a toilet and shit again. The bed pan days were over, it felt as if the arduous journey through the Mines of Moria had finally ended.
On day two they brought me a wheelchair and I was able to eat in the canteen. It was novel to sit at a table and eat again. Lying in a hospital bed for weeks, my entire life had stopped, using a table again was a stark reminder of how much I had relied on other people to sustain me. That was changing.
I had my first physio session which was a challenge. No longer confined to the 15 min bed sessions with the physios in the hospital. Now I had an hour with Madiga in the gym. It was so good to exercise again and I felt some life returning. It wasn’t clear how long I would be in rehab but I would be able to do ‘home visits’ to assist in the transition back to the outside world. First for a day and then for a weekend.
A Week in Rehab
Routine established itself quickly. I would wake at the customary 5 am for coffee and wait for the rehab doctor to do his rounds. I asked him if it was possible to change the blood thinner injection to a pill form, which he agreed could be done. Long bone fractures and big wounds create a high risk of blood clots. Since day one I had been given a daily injection of Clexane into the fat of my belly. It was a painful daily experience. Wednesday marked the first day since the accident that I had not had a needle of some kind either permanently attached or stuck into me for some reason. Although I had the TSF through my leg, it was still a relief and a huge milestone for me.
After breakfast in the canteen each day I would head to the gym. I did two sessions each day, one with the physio and one with Nelia the occupational therapist. Both Madiga and Nelia were amazing, without them guiding me through the first phase of rehabilitation I doubt I would have made any progress at all. Whilst the exercise tired me out and the pain that it caused at the end of the day was incredible, I felt better for it. Finally I had some agency of my own on this journey instead of being a passive bystander as doctors cut and stitched me back together.
Standing using a walking frame in the physio sessions. Photo by Unknown
The freedom of movement and the canteen allowed for more visits from friends and family. Again it struck me how many awesome people I had met in my life and the support was invaluable. On Thursday I met the trauma counselor and discussed my feelings with her. She was far easier to talk to that the psychologist who had come to see me in ICU. My attitude continued to improve each day bolstered by the activity and conversations with friends, family and rehab professionals. The week had been exhausting. I was learning how to navigate the world with one fucked leg. As such it had taken every bit of me to stay with the flow of events in the first week of rehab.
A Time to Reflect
The first weekend in rehab I would stay there, not yet able to take on the rigours of a ‘home visit’. I would do one physio session on the saturday but otherwise rested. Sleep was better thanks to the exhaustion of the exercise and my mood had improved considerably. I had pizza with my mother and sister on the sunday, a welcome break from the hospital food. It was quite a social weekend for me seeing friends and family but the empty hours between the visits were still torturous.
Some form of normality after the bleakness of the hospital. Photo by Unknown
The pain was still considerable and the weight of the loss weighed heavy on me. I cried many times that weekend as the reality dawned afresh. Each new ability I gained (transferring into a wheelchair, using a toilet, brushing my teeth at a basin, eating at a table to name a few) came with a bittersweet feeling. Although I was elated to be making progress I was acutely aware of the ability I had lost. Every gym session or excursion outside stung with the memory of my previous life. Like a cold and final reminder that I would never live my dream of becoming an 8A climber.
I was, however determined. Tool had released a new album, Fear Inoculum. Once again I would turn to their music to help me on the journey. Pneuma reminded me to keep my eyes full of wonder and Descending would help to keep me on the path to order. I had trained myself both physically and mentally to lean into challenges and I resolved to do just that. I would remain true to my faith in Being and Like Marie, it was time for me to demand “…give me my, give me my wings”. Thank God for Tool.
It was raw and challenging but the journey into the unknown had begun and like the warrior in Invincible I would struggle to remain consequential.
This X-Ray was taken about two weeks after the surgery to install the Taylor Space Frame. It was a stark reminder of how my life had changed. Photo by JM Watson
The Last Days at Christian Barnard Hospital
The bottom is an ugly place, but that is not to say that it is not useful to reach it. When I awoke on Friday morning, frustrated, in extreme discomfort and emotionally depleted, I knew that I had indeed reached the bottom. I also knew that there was utility in that and I felt just slightly better for it. Although the day was no less grinding, I did meet with Dr Laubser who would install the Taylor Spatial Frame (TSF) around my leg. Finally it felt as if I was moving again, impossibly raising my head to breathe after drowning in chaos and despair.
He informed me that I would be able to bend my knee and weight bear post surgery. I would also not need to stay in hospital whilst the bones healed. Something which was not certain in my mind and a huge relief. I would be transferred to a rehab facility after about a week of observation and healing in the hospital. There they would help me to regain enough functionality to be released from hospital with the TSF. Exactly how long that would take or in what condition I would be was unclear. But at last there was hope and a foreseeable end to the hospital stay.
The next few days passed like decades. The same routine of early mornings, physio and doctors visits punctuated long hours of attempting to entertain myself by reading, watching YouTube and generally being an emotional mess. I wasn’t sleeping much better. I was, however, able to get a few patchy hours each night which helped. They transferred me to a private ward due to an infectious pathogen they had found in the tests they routinely did. The doctors said it wasn’t infecting my wounds but needed to isolate me from other patients.
The visits from my mother, sister, brother-in-law and friends sustained me, keeping my mind in check in the otherwise endless hours of neon lights and immobility.
The Taylor Spatial Frame Surgery
I transferred to Vincent Pallotti on Wednesday afternoon. Thursday Morning was an anxious time waiting for the surgery that afternoon. I knew I would be going back into a more painful state after the surgery. It meant more IV drugs and altered consciousness. The confused state precipitated by the drugs combined with the massive psychological trauma was not conducive to sanity. It took everything I had to hold on in those periods.
The Surgery was a long one and waking up in the recovery area was as confusing and unpleasant as I could possibly have imagined. I phased in and out several times before stabilising and I was in considerable pain. I could feel the same fractalization of reality between bouts of lucidity as I had when they gave me the Ketamine. Again I found the words of Dr Peterson useful: Shorten your timeframe. I tried to breathe and make it through each second. Not fully aware of where or at times even who I was.
My first view of the TSF, relieved to have the other ex-fix removed. Photo by JM Watson
My mother and sister were in the ward when I arrived, I was in considerable pain. The anesthetist had given me a PCA. It’s a large plastic syringe like pump that allowed me to self administer IV painkillers every seven minutes. This alleviated the pain somewhat but at the cost of lucidity. The pain would rise and I would push the plunger. Several seconds later I could feel my consciousness narrowing and be sucked back into the fractal world beyond. The struggle was real.
An X-Ray taken a few days later, the shattered bone and the screws holding it in place clearly visible. Photo by JM Watson
Hope, and Desperation Post Surgery
Surprisingly I slept quite well that night, but awoke feeling exhausted. Dr Laubser informed me that the surgery was a success in his eyes. A relief but it did nothing for the pain. The first physio session was unnerving to say the least. Bending the knee after almost 6 weeks of it being stationary was an uneasy feeling. It felt as though the whole knee was in a vice grip and it was more than i could bear to feel all the wires and pins inside me. I politely asked to end the session and subsequently broke down crying when the physio left. I felt stretched beyond what I could handle by the end of the day. Music helped to alleviate the burden of being until the sketchy sleep covered me.
The pain improved over the next few days but not by much. I was barely able to move around in the bed. Sunday was the next day with anything other than the routine of hospital life and visits from family and friends. The doctor cut away the protective bandage covering the TSF and I could see it for the first time. As always the sight seemed both shocking and intriguing at once. This thing before me, both biological and mechanical is what was left of the the leg that held a heel hook on Human Energy, a toe hook on Born into Struggle and hiked countless kilometers into mountains unknown. Now I could barely move it and not at all without pain.
Top view of the STF. Photo by JM WatsonThe marks drawn on my knee helped the doctors align the TSF. Photo by JM Watson
The nurses also changed the bandages on the wounds still healing between the Meccano set and replaced the sponges around the pin sites (something I would later do each week on my own). Later that day the physio would help me move the leg over the edge of the bed and slowly lower the foot to the floor. The pain and discomfort was real. I was only able to sustain that for several seconds. I had touched the floor for the first time since the accident, a momentous milestone.
Dressing change. Photo by JM Watson
Dr Laubser also started the adjustment of the TSF, a process which would continue for 5 days. The support struts of the TSF which join the two rings together have a locking screw mechanism that allows them to be lengthened or shortened. A computer program determines the correct sequence of adjustments needed to correctly position the rings to align the bone shards. The movement is spread out over 5 days to lessen the pain and allow the body some time to adapt before the next adjustment. Whilst the adjustment wasn’t painful, it did precipitate more inflammation. I felt more pain at the end of the day after the adjustments.
The next few days passed much the same. The pain did begin to lessen and I moved away from the trippy drugs, thankfully. I did my first stand heavily assisted by the physio and with all my weight through my arms on a walking frame. I was only able to do one stand the first day. Progressively adding two more the next day and three the day after that. The journey back to the mountains seemed impossible. I was still in a dour mood for the week after the surgery, despite the progress and the hope it had brought.
My first touch of the floor for about 6 weeks. Photo by Lyal (Thank God for that guy)
The Last days at Vincent Pallotti Hospital
By the weekend I had recovered a bit more, I was in a lighter mood when My birthday came. I ate burgers with my mother and sister and although I was still distraught, I was eager for the transfer to the Rehab facility.
Love had been lost and purpose had been expunged from my life, all that was left now was suffering. Thankfully I had asked for a copy of Mans Search for Meaning by Viktor Frankl, which I had intended to read whilst in Rocklands. His words brought some dignity back to my mind and remembered in me some of the thoughts which I had cultivated over the few years prior.
” When faced with unavoidable suffering, suffer bravely” Viktor Frankl
Damn how I tried, through the tears and the pain. Looking back on that period I understand that I succeeded in rekindling hope. At the time, however, I could not see the forest for the trees. The forest had apparently seen me and was preparing the reveal itself. After spending a week and two days in hospital post surgery, I would transfer to rehab on Monday the 26th of August.
First, a warning: This post details a time where the realities of life were stark, the gruesome details of the operations were something which I needed to get used to very quickly to keep abreast of what was going on. I debated whether to include images from the operations here but in the end decided to keep with the idea of being as truthful about the journey as possible. Parental guidance is advised.
Me on Born into Struggle 7B+ Photo by: Unknown
My Memories of this time lack continuity, partly because the doctors gave me drugs to prevent me from forming memories and partly due to my own reluctance to continuously rebuild those memories. I will try to recall salient thoughts and emotions from this time as write but mostly the information I have has been taken from the accounts of the doctors involved and my own journal which I started keeping on the Tuesday. I was more recording a timeline of major events that detailing my emotional or psychological state, I didn’t really have the energy to do more than that.
Monday 14 July 2019
Firstly, I don’t really remember waking up for the first time. I don’t recall my sister and her husband seeing me awake on Sunday whilst still intubated, in fact I don’t remember being intubated at all. But apparently I did wake up on Sunday, albeit under serious drugs. The initial operation had ended early in the morning and I was in again on Sunday Morning. The first memory I have is of waking up on the Monday morning. Or at least being awake, I don’t fully recall the moment that I awoke. Rather like being in some dream, I was aware that I was conscious but with no real recollection of arriving there. I was alive and that certainly seemed to be a good thing, although there was serious pain. A kind of ‘this isn’t just going to go away pain’. I was also in some shock, there was a lot going on. On top of that I was also high. A kind of dull high Id never experienced before and it wasn’t altogether pleasant. My lips were dry and cracked, my muscles ached, my throat was sore and I could barely move. It was bad, maybe not the worst that there has ever been, but pretty fucking bad.
My bed in ICU (Taken during the second week) Photo by: Carlien Wassermann
So what then had actually happened to me? When I arrived in Christian Barnard Hospital, I was in a state called pre-renal Failure, from what I understand its just before your body starts giving in and you get into serious trouble. I had lost a lot of blood, one doctor estimated I received around ten units of blood and a few units of plasma and platelets. About four and a half liters in total, an estimated 80%+ of my total volume of blood. The loss of blood combined with the dead tissue of my right leg was putting a lot of pressure on my body. There is a measure of lactic acid which they monitor during trauma, when I was put under my measure was 10 mmol/l where about 0.5 to 1 is average. This Lactic acid buildup is a reflection of the body’s oxygen consumption outweighing it’s ability to deliver oxygen. An inability to deliver sufficient oxygen and to remove a buildup of CO2 were starting to threaten my life. Apparently when I went under my blood pressure fell quite substantially and to keep me within limits the doctors had to use various vascular constricting and heart stimulating drugs to keep the flow of oxygen sufficient. Despite the drips and ongoing transfusion of blood, the anesthetist manually injected blood and plasma with a syringe to boost the amount of fluids going in and raise my blood pressure. In the end it was pretty close, they didn’t actually need to resuscitate me so I guess it could have been closer, but it was close enough that the doctors were concerned and also relieved when my vital signs showed a large improvement post surgery.
My Left Leg was smashed just below the knee. The head of the Tibia bone, which forms the bottom of the knee, had been broken into three separate pieces and most of the bone directly below it at the ‘fracture’ site was so badly damaged that they needed to remove it. The small shards of bone apparently don’t get sufficient blood supply, then die off and cause infection. Large pieces of the muscle and flesh had also been damaged. They had cut my leg open on both sides to relieve pressure caused by the swelling. The pressure had lead to compartment syndrome and was stopping blood circulation to the muscles. The Fibula had been displaced and broken at the top. The loose bottom section of the Tibia had been stabilized with an external fixation device using pins which screwed into the Fibula and the Femur above the knee, carbon fiber rods and bolted clamps kept the pins and bones secure. The wound was still open but covered in suction bandages to drain off the blood and plasma draining from it. The doctors were as yet uncertain as to whether they could successfully save the leg.
A video taken during the operation shows the extent of the damage Video by Carlien Wassermann
My Right leg was amputated above the knee and the doctors were apparently trying to leave me with as much of a stump as possible although they were concerned with the amount of viable soft tissue available. The trauma had been contained but the leg was not yet closed. Again suction bandages were used to drain the wound.
The initial surgery to save my life and remove my right leg took around 4 hours and ended at 3:07 on the Sunday morning. I was then taken back to theatre later that Sunday by the orthopedic surgeon to fit the external fixator.
To say that I slept on that first night in ICU wouldn’t be quite accurate, its as if I continuously faded into and out of a nightmare. The nightmare part was when I was awake, pain, the effects of the drugs, the constant churning and beeping of the monitors and the machines that regulate the flow of drugs, the business of the nurses and patients coming and going and the shock of being in a hospital with only one leg which could still be amputated.
Tuesday 16 July 2019
Tuesday morning came, although in ICU there is scarcely a night time due to all the activity, and it was back to theatre at 08:20 AM for about three and a half hours, the doctors would continue to work on the left leg . Debriding the wounds, cleaning out more fragments of bone and removing more dead or dying tissue around the wound. Again I came out of the operation in pain and exhausted, it was like all the energy in my body had been depleted, everything I had was used up, maxed out. It was all I could do to try to get through that day moment for moment. I ate some bean soup that evening, although I was not allowed to eat the beans, my digestive system had shut down and the drugs almost guarantee that you get constipated, an issue which would prove to be a problem in the days to come.
Wednesday 17 July 2019
My father arrived from Italy and came to see me in the hospital. It was encouraging to have my family there and without their support during this time, I doubt I would have had the fortitude to continue.
I was taken to theatre again today for the vascular surgeon to do an angiogram of my left leg. Essentially they use an MRI machine and a dye to track the functioning of my blood vessels. They inject the dye into the vein in your pubic area and then uses a pressure bandage to close off the injection site to help stop the vein from bleeding. The anesthetist apparently used some kind of clearing agent drug to wake me from the anesthetic. The effect was to neutralise the painkilling drugs in my system. The procedure wasn’t long but I awoke fast and in considerable pain, post operative shock set in instantly. I was shaking, sweating, cold and breathing in gasps. It felt as if I had just been hit by the rock again, only this time I was already in Hell when it happened. Back in the ICU it took around two hours for me to ‘normalise’ again. Later that evening I had my first real food since the accident, Chicken (lets just leave it at that).
Thursday 18 July 2019
My mother arrived and I saw her for the first time, I also learnt of the amazing amount of support that I had from friends, acquaintances and colleagues outside the hospital. The realisation of how many people I had connected with in my life was staggering.
The doctors placed an ‘epidural’, which is essentially a continuous local anaesthetic applied directly to the spinal cord. They insert a catheter between the vertebrae and into the the area surrounding the spinal cord, a process which is quite unpleasant I can assure you. It did however, help with the pain. For the first time since the accident, my pain was lessened on a more continuous basis. Before then I had had moments that were pain free, but they would be induced by the doctors or nurses giving me some hectic dose of drugs that would reduce or even pause my consciousness. Sure, the morphine, ketamine and precedex were helping to manage the pain, but the epidural really improved things.
I was again taken to theater for around three and a half hours. They continued the process of closing my right leg, they sutured blood vessels and soft tissue and reapplied the vacuum dressings. They also worked on the left leg again, removing further bone and suturing more of the muscles and other soft tissue to try to save the leg. Again I awoke in pain and exhausted, I had this feeling that the world was happening to me and there was in fact very little I could do to change the course of events, I was a passenger on this rollercoaster through Hell and every operation was like a limitless fall further into the black, hot darkness.
My left leg at the end of the first week Photo by Carlien Wassermann
Friday 19 July 2019 – Sunday 21 July 2019
Although I technically didn’t have surgery on the Monday, it still felt to me as if i had. I had woken up for the first time in recollection since the accident on Monday and it felt as if this Friday was the first day on which I had not been to theatre, and what a relief. To know that there was a break from this constant in and out of induced unconsciousness and that I could just rest was incredible. The journey to this point had been so dense and chaotic, new people, new experiences and a large amount of learning to stay informed on what was going on. For the most part I just lay there over the weekend reeling from the traumatic events of the past week. The nurses turned my bed inside the cubicle so I could look out the window, although it was raining and cloudy, I could still see the Hottentots-Holland Mountain range in the distance. Once my home and my passion, the mountains now looked like some far away land, beautiful and inaccessible, simultaneously alluring and jeering, as if the world was saying ‘Yea, you want this, well then suffer…’
There were no answers, there was no reason, my emotions ranged far and wide; Courageous, born out of my lessons in climbing; Grievous, born out of the complete devastation of the future; Fearful and frustrated from within the present moment. People often tell me how I was so positive during that time and that that’s what got me though, I can’t say I agree with them, I was just trying to stay with it, trying to hold on to some kind of sanity amidst the sudden and terrifying chaos which had so rapidly consumed me. Perhaps it is just such striving to overcome that is the core of positivity, it has occurred to me before that its genesis is such. There might have been no answers, but by the end of the weekend I was clearly faced with the question: Do you have the will to suffer? You can give up, but if you have the will to suffer seemingly without end, if you truly ask that question, in all its seriousness, through all the sacrifices you will need to make to learn the answer, you do not know what you could become. When all else is washed away, when reality is so overbearing that you get faced with this question in its full undisguised nakedness, the choice between two options becomes quite clear: Suffer bravely and voluntarily, or cast yourself down to the end of consciousness.
Plate V of an artwork contemplating the idea of Fate…By: Jethro Watson
I awoke with such calm. If it is at all possible, this was were I was meant to be. My dogs came in for their morning hellos, a quick cuddle and a reminder that they wanted to go out, there was a whole world out there to explore. I opened my tent and stepped out into the cool Cederberg morning, stunning in its winter clarity. I walked down the road to where it overlooked the dam and waited for my dogs to come back round the corner. I felt an alignment so deep that my entire being was at peace, my dogs, this place, the sacrifices, the training, the transformation, the achievement. It was as if I had discovered some kind of personal cosmic compass and although I couldn’t put it into words, I felt that I was firmly heading in the right direction. I walked back to my tent, made a fresh press of coffee, the click of my gas stove and the smell of coffee in the tent were hallmarks of the life Id chosen to live. A nomadic life of climbing, and living in the outdoors with my dogs, wherever that might take me. I walked over to greet Nick, we were heading out to a new area, time to do some first ascents in Rocklands.
Home in Rocklands Photo by: Jethro Watson
We drove out and parked on the side of the road at the top of the Pakhuis Pass closer to Clanwilliam than most of the established climbing. The amazing vistas which greeted us in that section of the pass were novel and beautiful, ridges of rock and green, and a valley with secrets untold. My dogs were loving the freedom, no paths and large areas to explore as we walked out to find Nick’s project, a proud highball boulder which he said could go at 7C or higher. I wasn’t planning to climb it, just to take photos of him doing so. Id climb something altogether more tame, something a bit safer. The area was a maze of rock we went over the ridge but we didn’t take the most direct path. Nick eventually found what he was looking for but we would have to go round and up to get there. The going was kind of tough and the uphill was tiring. But we were almost at our destination.
The details are a bit sketchy in my mind, perhaps it was the tiredness of the hike and uphill, perhaps my mind just stopped recording to make way for my body to act. I was approaching a ridge of some one and a half meters high, I was trying to circumvent this ridge when I noticed that the rock I was passing was moving too quickly. Going up hill as I was, I was expecting to see first the side then the top of this rock, which I did, but something in my mind clicked that this was happening too fast.
On the left is the shelf from which the boulder slid…In the lower right corner is the boulder that assailed me Photo by: Nick Muehlhausen
My body moved fast,
especially considering the weight I was carrying, I remember pushing off with
my legs and turning at the same time, desperately trying to put distance
between me and the boulder coming towards me. I remember hitting the ground and
feeling the push of the boulder that kept my momentum going further than my
initial jump. I remember feeling my left leg bend back up and over my knee in a
very unnatural way, the acute snapping noise of the bone breaking and then an
intense pressure on my right leg. My adrenaline spiked, I could feel the rush.
The pain hit me. But what hurt I couldn’t say. My breathing was sharp. The pain
was everywhere.
I knew I had issues.
Breathe in, I told myself. Pay attention, assess.
I turned to look
back at my legs, the left was bent out under the knee and was clearly broken,
my jeans were torn and I could see the blood.
Well, that’s not good.
My right leg was
pinned at the knee under the boulder, I couldn’t tell how badly injured it was.
But I knew I needed help, and fast.
“Nick” I
yelled.
“Are you
okay” He answered.
“No”
“I’m Coming
buddy”
Nick came dodging
down the mountain slope to me. He took one look at me and went into action,
trying to assess how to get me out from under the boulder.
“I’m gonna get you out of here bud”. He tried to lift the boulder without effect. “Ok I’m gonna try to get your pack off”. My head was reeling and I was breathing hard, the pain and shock taking full effect. But I used the adrenaline rush my body had reacted with to keep me focused, there was work to do. I helped Nick unclip my pack, just to stay with the process more than being useful. He got the pack off me and looked at the pinned leg, digging around it to clear some space. He said I was pinned on a rock underneath, I tried to turn slightly, more onto my stomach, to see if I could get the leg into a better position to pull it out. I think this worked but the pain lanced through me like the fire of hell itself, I realized the damage must be pretty bad.
“I’m going to
try to lift it” which brought me back out of the alternate dimension of
pain.
I looked around and saw an exposed rock in front of me, there was a small ridge I could crimp, I readied myself. Nick lifted, the boulder moved, I pulled and was free. By some Power of Greyskull, he had lifted that thing and got me out. He helped me move into a more ‘comfortable’ position on my back. The pain was all too real, It was all I could experience, every other sense dulled by its insistence. I was breathing sharply and erratically, my breath and the involuntary screams controlled purely by the pain.
Nick looked at my
right leg, “Man, you are broken” He said. “I’m going to
tourniquet it”
I couldn’t see what he was doing, I couldn’t lift my head, my struggle was elsewhere, internal at that point. Trying to drive sanity back through the shock and pain. As he pulled the tourniquet tight around my leg, I screamed. But somehow it helped me back. The pain which had been the unravelling of my mind seconds earlier, seemed to tether me to reality. I raised my head to look at Nick.
“Do I make this
man”
“What?”
“Do I make
it”
“I’m gonna get
you outa here okay”
He gave me a bottle
of water, I drank some and splashed some on my face. This helped bring me back
into the moment again. “I feel really bad I cant be here but I need to get
help” Nick said.
“You need to do
what you need to do, please hurry, I don’t want to die from loss of blood”
He stood, turned and ran. I was left alone with the pain and the uncertainty of the severity of the injury. I could barely move due the pain, let alone sit and an examine myself. I had no idea if I was at risk of death or not. The pain and the shock were overwhelming, I had no idea where I was. Would I live. Would I walk again. Would I climb again. It was all too much and my sanity crumbled.
From then time
became distorted, my mind went into automatic. It cut out certain elements of
reality to focus on what was necessary. It focused internally, through the pain
and shock, through dreams of the future and layers of the past and found what
it needed to survive. Focus on Consciousness.
Focus of Breathing. Don’t think about the future. I was in uncharted
territory, plunged through that thin sheet of ice that we walk on every day,
down into the deep cold water below. It was Chaos. I had left order and was
firmly in the realm of Chaos. But I was still there, and that pure state of
experience held a special sort of significance.
Focus. Focus. Focus on consciousness. Aaaargh. No. Focus. Focus on the moment, you could do that before…do it again now. Aaaargh. Focus, dammit. Focus on this moment. Focus on your breath. Breathe. You need to breathe. Breath in. Brea… Aaaaaaaargh…ok don’t move…Breathe in…breathe out…slower…breathe in…breathe out…ok this is working….argh…stay focused…drop into that space where its just experience….breathe in…breathe out…but the pain. Argh. Aaaargh. Water, need water.
I craned my neck over to see the bottle, i managed to reach for it. Although every movement cost me pain, I had seemed to gain some composure through this brief journey into this internal world of consciousness. I drank, the cool water did refresh me, but unable to control my sharp breathing I coughed. This was unbearable and the water splashed over my face from the bottle. As the cool water hit my face and it caused me to gasp and then scream. It wasn’t only a scream of pain though. This was different, this was more determined. A scream of anger, a scream of hope, a scream that came from a place of resolve. Had I not been here before? Had I not calloused my mind, as David Goggins had said, had I not put enough friction and challenges in my life before to know how to overcome this? Had I not been humbled enough before to be able to get through this? I laid my head down again, this time more determined. Embracing the pain, I breathed in again.
Breathe in…Breathe out…Breathe in….Breathe out…embrace this moment…don’t judge, just experience…shorten your time frame like Jordan Peterson said…when you’re faced with inescapable suffering…shorten your time frame…if a minute is too long then all you have is a breath…breathe in…breathe out…aaaargh…its too much…no…just breathe…what if I don’t make it out…my dogs…breathe Watson!…
But it was too much again and the world started to spin. Thoughts of the future, the possibilities and the pain overwhelmed me. With my mind racing out of control, a feeling of massive frustration built inside me until it became a rage. This time the scream was intentional, a primal beast of terror and anguish.
Ok you’ve had your moment of weakness now…you got rid of that emotion…no more future now…no more past…just breathe Watson!…Breathe in…Breathe out…slower now…Breathe in…Breathe out…What did Sam Harris say…just rest as that space where things appear…I am not this pain…I am only in this moment
My mind kept to its task now, somehow found a way to stay focused on the moment to greater or lesser degree until Nick came back. “Jethro” he called. “Nick” I yelled. He came back and told me help was on the way. I lay back and focused on breathing, the pain hadn’t subsided but my ability to withstand it seemed to have been bolstered by the meditative state my mind had found. “The medics are on the way” Nick said, “Okay man, I wanna live”. When Timmy from Klein Kliphuis arrived I told him the same Thing “I just wanna live” It had been a long internal struggle to withstand the weight of the all too real situation, but I was determined to fight. The medics arrived sometime later, I’m told it was about two hours from the incident, time had ceased to work in a normal rhythm to me. My reality was breathing and consciousness, punctuated by salient events in real world: James from Alfa arriving, the medics putting up an IV for what I presumed was morphine, the pain lessening slightly, the medics dressing my legs and moving me to a stretcher (both of which caused me to cry out involuntarily in pain). I remember them talking on their radios about the helicopter and our whereabouts, at last we heard the helicopter approaching.
The Medics stabilizing me on site…The damage to the right knee visible Photo by: Nick Muehlhausen
At first they couldn’t find us, the sound of the helicopter growing louder and then fading again several times. Eventually they found us and came in low, they lowered a paramedic to help roll me into a stretcher to be airlifted. He explained that they couldn’t land and I would be lifted along side the helicopter for a short distance and then land to be brought inside. Safely inside the helicopter I realised I was freezing, a problem aggravated by the fact that we needed to refuel and protocol said we needed to have the door open for that. The winter air coming into the cabin was freezing. We landed at Milnerton hospital at 18:40, about seven hours after the rock hit me. They wheeled me into a room with some kind of scanning machinery on the roof. I presumed it was an X-Ray machine. I really wasn’t sure what was going on at this point. I was on drugs for pain, tired and cold. My ability to focus was waning.
In the stretcher waiting for the helicopter Photo by: Nick Muehlhausen
To move me from the stretcher to the bed, they game me Ketamine. Ketamine, I later learnt, is used because it dissociates one from reality and reduces pain. It’s effect is powerful but relatively short lived. It helped with the pain and made the transfer easier. But the effects didn’t stop there. I was lying prone, looking up at this X-ray machine which was a very foreign looking thing, grey and white and black. My feeling was gone, I was floating on my stretcher and it had gone quiet, quiet like my hearing had failed. I was suddenly aware that my vision had gone very wide, it was as if my vision no longer had a boundary. When I tried to look for the end of my vision all I found was a repeating sequence of colour. Black and grey and beige, like a repeating fractal or an Escher like construct. It was everywhere, it consumed everything. I can only describe the experience that followed as and Ego death experience. I had heard of this idea in some of my research into taking psychedelics. The idea that the world turns into pure experience, to the extent that your identity ceases to exist. The fractal became that experience, it was in front, on the sides and as my vision looked back through where I should have been, there too was the fractal. It was all there was, repeating, changing and everywhere. And then it began to clear. At some point an ‘I’ became aware again, and the ‘I’ was very confused. Who was ‘I’, Where was ‘I’, and what the hell was going on? It struggled to grasp for any meaning, a thread of what that ‘I’ was. I knew I wasn’t born now, spontaneously. I had a feeling that there must be some nexus which caused this reality to be. I worked back through my disjointed memory of the last events in my mind, each one unfolding before me like a new event in time until I found the boulder crashing down on me. Boom, like knowledge uploaded in the matrix, I had a continuation of self again. A self which was somewhat in shock, in pain, but still determined to live.
I brought myself to, and decided to focus on the outer world for the time being, lest there was another one of these ego-death trips. I didn’t want to have to battle through that again in my state. I made conversation with the people there, I didn’t know if they were doctors or dentists but somehow I got them to play music, Tool of course. In my not so together state I convinced them to play Invincible, a song about feeling time exert its inevitable pressure. Although this seems folly in a situation where time is quite apparently limited, but the correct response to feeling time so acutely is to fight it, not to succumb to it. You fight it by trying, trying to be productive, trying to create, trying to stay alive.
By this point they
had called my sister and she had arrived in what seemed to me to be a very
short space of time, but how could I tell. I was really kind of out of it. I
remember asking, “If I pass out now, have you guys got me?” because I
wasn’t sure if I could maintain this conscious connection anymore. Determined
as I was the drugs and the tiredness were taking their toll. I don’t recall
their exact answer, but I remember that I wasn’t convinced.
They transferred me to Christian Barnard via ambulance. I remember the ambulance drivers were really awesome, friendly and positive. They made the ambulance really warm to help heat me up, I was still cold as stone. At Christian Barnard hospital I was again wheeled into a theatre and here met a very focused and concerned looking woman that I would later learn is Dr Kirsten Bischof. She went to work examining me. She touched here and there on the legs and feet and asked me what I could feel. I answered as truthfully as I could. She discussed something with her colleagues, presumably looking at the X-ray scans done earlier.
She came to me
looking very serious, she said that I was very sick, I had lost a lot of blood
and I was in a serious state. She said the right leg was dead and that the dead
tissue was putting a lot of pressure on my body. “We need to take the
right leg to save your life”. “Well then we need to do that” I
said, somewhat surprised at my response. They were going to amputate my right
leg and this didn’t really seem to be such an issue. It needed to be done so I
could live. Shorten your time frame, I
told myself, I just want to live. First this
then we worry about the future. Dr Bischof confirmed that they were going to
amputate the right leg and, for now, try to save the left. She wanted extra
scans done to make sure and to give her more information for the operation to
come. She added that we need to hurry, that I needed to get into theatre soon.
Whilst it wasn’t quite fear that I felt, I was certain that there was a
pressing need for something to be done to prevent me from dying. Its an odd
feeling knowing that you are at very real risk of death and there is in fact
nothing that you can do about it. It will now either happen or not.
The X-ray of the Right knee…First from the top and then from the side
They wheeled me into the MRI room, despite the drugs, the pain when they transferred me from the bed to the dolly was intense. I think by then my ability to withstand the pain of my bones moving and grating against one another had more or less dissolved.
The X-ray of the left Knee…Again first top and then side
The look on Dr Bischof’s face was grave when she had told me that I was in a serious state, I was certainly not convinced that I was in the clear. Had I come this all this way to die on a theatre bed. No one had told me, “don’t worry, you’ll make it”. It was a possibility I had to consider. So if this was to be my last few moments of consciousness, I had better make peace. I didn’t want to be fighting of fearful when they put me under. Through the haze of pain and drugs, my though process went something like this.
My body is broken…too broken to fix…So I’m going to die…in some sense I have already died…and I need to accept that…At best some part of this identity will survive…at worst, none, and the conscious experience that is me will be no more…Am I ready for that? Well, that’s not exactly a fair question is it…is anyone every ready? I have things I would like to achieve still…but if this is it can I say its been a good life…a life that was actually worth living…..I come from a good home with parents who loved me and gave me a great start to life…They gave me access to experience and education…I’ve overcome adversity, that’s a good thing…I’ve achieved things, built buildings, helped others do so as well…and I’ve climbed, if personal achievement is any measure for life then yes…its been a good one…I could have done more, I could have given back more, but I’ve achieved things I could never even have dreamt of…dedication and sacrifice paid off…if I’m to go now I’ll take that as a win…me 1, the suffering of reality 0…and that’s at least a light to shine in the darkness…perhaps that will inspire people…perhaps that will leave this world just a little brighter than when I arrived…goodbye Watson, you’ve done well my friend…
I remember lying on
the theatre bed looking up at the lights. I was ready, in what ever way I could
be in that moment. I was peaceful at least. One way or another, this life had
come to an end. The anaesthetist said something. The world went dark, consciousness
slid out from underneath me.
They say a good place to start is at the beginning, but perhaps that’s too far back. The beginning can only really be understood in the context of the now, it being a memory after all. That context is the nexus of this journey, the day my life changed, as epic as that sounds.
So where to begin then, well perhaps not the beginning but at least we should have a reference point, an understanding of what life looked like before the fall. A fall from Paradise into Hell. So this is what paradise looked like for me at the time.
Some 8 or 9 years ago I was on the road, nomadic in some sense, a recurring theme in my life. I was born in Cape Town and lived there for 25 years until my life fell apart after a breakup, a dwindling social circle, and economic collapse and depression. The company I was working for ‘asked’ if I wanted to go work in Port Elizabeth, so naturally off I went. This turned out to be a time of rebuilding and experimenting, it lead me to many odd chance encounters and perhaps too many hangovers. As work dried up in Port Elizabeth I found myself moving to Pretoria, again for the same construction company. This time however I was more optimistic than the move from Cape Town to Port Elizabeth, keen to see where the wind blew, perhaps keen to keep running as well. Running from what, I wasn’t quite sure. Having no friends there, I did what was necessary to make some, I searched for things to do. The thing I found was The Barn, a small homely climbing gym east of Pretoria on a smallholding, surrounded but not much but grassland. Here I met James, his dreadlocks and smile were all I needed to decide to invest some time there.
A Sport that Changed my Life Photo by: Dan Bates
I had climbed before, briefly in junior school and again during University but it had never really inspired me. That was to change in the coming years. The barn became my social center and I quickly made friends with the regulars and the owner Paul. Fast friendships were made before I had to ship out again to a hellhole called Standerton. I stayed there for a year and a half before finally losing it and moving back to the city, back to Pretoria. Overweight, unfit and still a bit disillusioned by my experiences, I started climbing again at the Barn I was privileged enough to be invited by Paul to live there in a separate house which was basically derelict. As part of my stay there I would refurbish it, turning it into a great gathering place for friends and climbers to share their stories. Soon, climbing and the lifestyle at The Barn had filled my life. As I began to explore this world, the meaning and purpose it inspired in me crashed headlong into my depression and my nihilistic beliefs. Climbing became the catalyst that would send me on a search for more answers. Later I would admit that climbing was the guide that pulled me out of that dark hole of depression and meaninglessness, although at the time I was still oblivious to all that, the wind was just blowing.
This continued and increasing devotion to climbing lead to some profound changes in my life. Over the years I would quit my job in construction management to have more time to climb. I would negotiate with my next company for flexible time which I could control to be able to go away for climbing trips. I stopped smoking and began to change my diet avoiding heavy carbs and sugars and also cutting out all fast food. A much healthier lifestyle ensued, all due to climbing. The improvements didn’t stop there, after having a severe back problem brought on by lack of core strength, i ended up doing two dedicated ‘one on one’ Pilates training sessions a week for three years straight and rebuilt my whole body from the ground up. Coupled with the two climbing sessions a week, running and actual rock climbing on weekends, an overweight and unfit 28 year old slowly became a climber and climbing slowly became the raison d’etre for my being.
I began to send routes and problems which I had thought impossible for me to complete, still low in grade compared to the global standard but monumental achievements for me. I remember sending my first 7a+ on sport and thinking, “I didn’t believe this was possible. But now that its done, who knows what is. Lets go and find out”. A 7b called Vandals followed which was the most exhilarating sport climb I have ever climbed. 7a sends came frequently and a several 7a+ sends only inspired me to push further. Sadly there was not a lot of bouldering in the north of South Africa. Especially after the closure of our small playground, called Ezemvello. An event which was devastating to our climbing circle in Pretoria, we had spent so many amazing hours there camping and climbing. This place above all others had inspired me to continue climbing,the beauty and the time bouldering with good friends will forever be etched in my mind.
Strong Arm of the Law, 7a Photo by: Paul Bruyere
Life at The Barn was good, I had moved into a cottage on my own there an would climb nights away with close friends, sometimes playing Magic The Gathering or some board game with them late into the night discussing life and climbing. With the flexible hours I worked, it was a lifestyle that allowed me time. Time to climb, time to think and time to explore the world of ideas. During this period of stability my sense of nihilism and depression had dissolved, replaced by a dedicated drive to improve myself for the purpose of climbing. I had the time to explore the ideas of many thinkers and had many a discussion surrounding life and its meaning with my friend Marc who lived there at the time. As I read, listened and learnt, my drive to improve became paramount and my quest for meaning insatiable. It wasn’t until I found the online lectures of Dr Jordan Peterson that I was able to fully articulate this new philosophy I had been living. I had been liberated from the nihilism of my twenties and I had become a fit and healthy climber. I was proud of my achievements, but something still bothered me, a sense of restlessness. A change was coming, the world of The Barn had taught me all I would learn there and it was time to answer life’s call to adventure with my new understanding and skills.
Last Day at The Barn Photo by: Jethro Watson
It was as this new person that I ventured forth from the solid foundation of The Barn to move back to Cape Town to see what else Life had in store for me. I packed up my belongings and sent them to storage in Cape Town, loaded my tent, gear and two beautiful white Alsatian dogs, Luthien and Huan, into my Toyota pick up and headed into the future. First stop was a month bouldering in Rocklands. That season’s climbing was good but I still felt that I was under-performing, a feeling that had plagued me for many trips there. That said I did send Human Energy, 7a, a long term project for me and Finders Keepers, my first 7a + on boulder, a magnificent climb. After this it was off to the crags of Cape Town, Montagu, Oudtsoon and Truikieskraal. I would flash my first 7a on sport, two actually, and add a few more 7a+’s to my list. Climbing was on the up. After sport climbing for a while, I would go on the keep up the training pace, returning to running and doing Pilates on my own. This renewed effort in training lead to me sending several 7a boulder problems in Cape Town some of the best climbing I have ever done, most were sent in a session or two. I was now a 7a boulderer, a grade which I had long envied. This life of sacrifice and training and a new philosophy of meaning was starting to pay off and it was time to move back to Rocklands to test my new strength and form.
Home in Paradise Photo by: Jethro Watson
Rocklands started off with some frustration, minor injuries like tennis elbow and back spasm kept me from pulling hard, until one day that just gave way to form. I sent a 7a+ at the Coup, a fantastic pebble conglomerate roof with a big move to finish; a 7a+ called Panic Room, a long pumpy roof problem with a slopey topout; and finally a 7b+ called Born into Struggle. This problem was on top of my list of projects and had inspired me many years back when I’d first seen climbers much more hardcore than I struggling on it. I sent it in a few sessions and as I topped out into the post sunset evening in Rocklands, it felt as if I was truly alive for the first time, a kind of peace that no instant gratification can provide. A kind of peace that only dedication and sacrifice can bring. That night Nick and I celebrated my highest send of a project that, 8 or 9 years prior, I couldn’t have dreamed possible. We cracked open a magnum of Kanonkop Paul Sauer 1989, arguably South Africa’s best wine. We toasted to success, sacrifice and a future of climbing. Life was good, perhaps too good. As it was, humility was in store for me. The next day my life changed, a precariously balanced boulder was to come loose, crushing my legs and sending me from My Paradise of Cererberg Climbing into a Hell which was truly difficult to survive.
