A glass half full: looking on the bright side

Thomas Wells explains how living with a disability has taught him what really matters in life

When I had a complete spinal cord injury midway through my medical school training in March 1992, I didn’t know whether I would be independently mobile, let alone work as a doctor in clinical practice. The essential elements that enabled me to achieve more than I could have ever envisaged are support, opportunity, choice, determination, and being able to focus on one or two goals at a time.

I was in my first clinical year at St Bartholomew’s Medical School in London when I had my accident. I was paralysed from the lower chest down, and I had a tracheal stricture as a complication of a tracheostomy. Reinsertion of the tracheostomy had been necessary, but the tracheal stricture above it meant that I was unable to speak until I had had major throat reconstructive surgery. Nevertheless, everyone at medical school in London was very positive about having me back. Fundraising enabled me to buy a lightweight wheelchair and have the remainder to put towards a car. This unconditional support was such a boost to my mental state when adapting to my situation, especially when considering whether I wanted to continue training to be a doctor.

Setting objectives
The rehabilitation process in hospital taught me much about setting objectives in that it was best to concentrate on the next hurdle rather than the distant goal. For example, having been on my back for over a month, I needed to be able to sit in a wheelchair without fainting before I could be independently mobile in one. Thinking too far ahead would have been overwhelming, and the end result was uncertain both in terms of whether I could achieve it and whether I wanted it. Also, I learned a great deal from observing how other patients in the spinal unit reacted to their situation. Anger, bitterness, and blame were such unproductive and energy sapping emotions. To achieve goals, one had to focus one’s limited energy on the objectives in hand rather than wasting energy on negative thoughts.

My return
After long and hard contemplation, I applied to complete my medical training in Bristol rather than London. My future was uncertain at this stage. I had become more independent after several months in hospital, and I could now speak, having had the major part of the throat surgery, though a tracheostomy still remained. Throat operations still lay ahead, in which scar tissue on the inside of my trachea would be lasered endocopically, and removal of the tracheostomy and operative success were not guaranteed. Also, I had not yet been discharged from the spinal unit, and I still needed to adjust to living independently outside the protective comfort zone of the hospital. Many of my family lived in Bristol, and having their support nearby was a major reason for me choosing to go there. Hospital discharge was planned for June 1993, and it was agreed that I could start at Bristol University Medical School in September of the same year.

The undergraduate dean was fantastically helpful, and he was realistically aware that I might have some difficulties in returning to study. We discussed ways around certain issues such as access to university buildings and where it would be best for me to do clinical attachments. Rather than precluding my return because of untested assumptions about my capabilities and participation in different aspects of the medical school curriculum, I was given the opportunity to discover what I could and could not do. What were the particular difficulties? I had to get through undergraduate exams like any other medical student, irrespective of having a disability, and the particular difficulties apparent to me were tiredness and pain. The tiredness improved with time, and this was almost certainly due to my improving stamina and the fact that pain had become less of an issue, not least in part to a neuropathic pain dose of amitriptyline.

After completing medical school, I had to come to grips with working as a doctor proper. Fortunately, the postgraduate dean approached me to discuss my career plans almost a year before I qualified in June 1996. He had funding to pay for me as a supernumerary for my house officer and two senior house officer years of work. This enabled me to work at hospitals close to my home base and to discover what I was able to do when working as a doctor, without putting patients at undue risk. I surprised myself in being able to do most medical procedures including lumbar punctures, chest drain insertions and central line placements.

Life is sweet
I am now a clinical oncology registrar in a numbered training post. This achievement aside, what has come out of my journey as a patient and experience of being disabled? I believe that I am certainly more aware of the patient’s perspective than I would have been. Also, I have perhaps altered colleagues' perceptions of the capabilities of disabled people. It is a good thing to have diversity in the workforce, especially in a profession that is about caring, and disabled people with often much to offer should not be excluded without being given the opportunity to show their worth. Moreover, I am more aware that work should not always be dominated by competition, despite there being inherent competition in the medical world. My involvement in disability teaching outside my day to day job has taught me much that is useful in my job as a doctor, and it is good to feel the expert in this area in some respects. Important personal relationships have grown: I am even closer to my family, and I have some very good friends and a wonderful wife.

It is remarkable what can be accomplished if given the opportunity. Rather than being an object of pity, I feel a very lucky man. I would say that I have a happy life. Living with a disability has been and continues to be a challenge, but it has opened my eyes to what gives quality to life. Perhaps I could even say that my glass is three quarters full.

This feature courtesy student BMJ 2005; 13: 133-176