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A Fox Lake Blog

Please Be Upstanding

After being horizontal for weeks, the day arrived when a consultant turned up at my bedside, surveyed me for a bit, spoke to the nurses in High Dependency and then told me that it was time I was put on the tilt-table.  “The what?” I said, in my Dalek voice, whistling through my speaking valve.  “I thought” said the consultant “you had expressed a wish to get out of bed?”  “I have” I responded “but I thought I’d be doing that in a wheelchair.”  The consultant rolled his eyes and explained that, having been horizontal for so long I could not be simply whipped out of bed and stuck in a chair as I would just immediately pass out.  Yet another consequence of a cervical spinal cord injury is having very low blood pressure and in combination with lying down for a considerable time, any physical elevation greater than a few pillows would see me swoon like a Victorian maiden within seconds. Therefore I would have to be reacclimatised to a semi-vertical state a bit like astronauts are acclimatised to G forces via enormous centrifuges but in a lot less exciting manner.  NASA would certainly laugh at the tilt-table.  It was, as its name suggests, a table that tilted.  It also had a few straps to stop people tilting out onto their face on the floor but that was the full extent of its technical complexity. 

Now, before we begin I need to do a quick rundown of blood pressure ranges, for those of you not au fait with what constitutes ‘normal’ through ‘this one’s about to faint’, ‘this one is definitely unconscious’ to ‘this one’s probably dead’.  If anyone is interested in my scale the other way it goes ‘this one is a bit stressed’, ‘this one is me fighting with a carpark ticket machine’ and ‘this one’s head just exploded’, just FYI. 

Blood pressure is measured in millimetres of mercury (mmHg) and is given as two figures – systolic pressure, the pressure when your heart pushes blood out and diastolic pressure, the pressure when your heart rests between beats.  These are shown as one over the other – ie an ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg.  High blood pressure is anything 140/90mmHg or over and low is considered as 90/60mmHg or under.  For the purposes of this story you may now immediately forget the high blood pressure stats as entirely irrelevant.  We are not going to be frolicking in that ballpark.

The procedure for the tilt-table was pretty simple. it was brought alongside the bed and the guinea pig (ie me) slid across from bed to table.  Like a lunatic in an asylum I was then affixed to the table by the means of leather straps around my chest, waist and legs and a blood pressure cuff attached to my arm.  From horizontal a small dwarf (it might have been a physio but I couldn’t see to verify and a dwarf would have been in keeping with the whole medieval torture chamber vibe) would work a crank handle to bring the table through various stages of tilt until a full vertical was achieved and whilst I was winched through the various angles my blood pressure would be taken at each interval to assess how I was coping and that I was not about to vomit or pass out or both.  Nobody is expected to get to vertical on their first go and the idea is that you do a session each day, slowly building up your tolerance.  My session did not start well when my initial, still horizontal blood pressure reading was taken.  I can’t remember what the diastolic reading was but the systolic was 76mmHg.  Consternation ensued as there was some general rule of thumb that if the patient’s blood pressure was lower than 80 then the experiment, sorry, exercise, had to be immediately stopped.  Noises were made about abandoning the whole attempt and putting me back in bed.  Dalek-voiced me was, luckily, able to interject at this point.  “If my blood pressure is already too low to go on this then how on earth is it going to get any higher?  I can’t stay in bed for ever”.  There was a silence so I helpfully added “Besides, it says you have to stop if my blood pressure is below 80.  It doesn’t say anything about not being able to start.” Let no-one say I wasn’t learning how to navigate the NHS. Everyone looked at me, then at each other.  Then they exchanged medical looks that could be basically translated as “f*ck it, let’s give it a go’

There was a creaking noise and I was slowly tilted about six inches.  My blood pressure was taken (still 76) and I was asked whether I felt faint.  I didn’t.  We cranked another six inches, BP dropped to 73, there was some flapping, I loudly told everybody I felt FINE, thanks so we carried on. Rinse and repeat another couple of times. There was however a slight hitch in my assurances – I had never fainted before so I had no idea of the warning signs and, in my attempt to get vertical as fast as possible so I could get out of bed into a chair,  I *might* have been exaggerating how well I felt.  To be fair I probably should have worked out that a loud ringing noise in both ears was not ideal, especially when coupled with my vision going white and a rising tide of nausea.  In the end however my attempt was stymied on the fifth tilt when my bp dropped to the low 60s and I apparently turned grey with blue lips whilst still declaring, by now somewhat feebly, that I felt fine despite not being able to see or hear properly and being on the verge of upchucking rhubarb yoghurt over everyone.  I was hurriedly returned to my horizontal state and then to bed,  much to my annoyance. 

Ultimately it took a few goes on the tilt table over the next days before I became completely vertical.  I still caused much medical consternation with my ridiculously low blood pressure but we reached a compromise whereby, probably very much against  guidelines, we ignored the verifiable data of the bp cuff in favour of just taking a judgement call on how grey or not I had gone before desisting. Once upright I then had to literally stand around for increasing lengths of time to get used to it.  This led to some alarmed looks from various ward visitors who had to walk past this bizarre figure randomly strapped to an upright table, still garbed in a natty hospital gown.  Some would smile at me nervously and some would just stare rudely. I took great pleasure in saying “Hello” cheerfully in my Dalek voice to the former and “Exterminate! Exterminate!” to the latter. Arf.

Eventually I succeeded in being allowed into a wheelchair and my exploration of the hospital beyond my HD ward began. I remember the first trip very clearly – Dad took me to Costa where I got to order a mango smoothie and sit chatting at a table once again like a member of the human race.  I couldn’t move below my shoulders and only had one half-functional hand but I was up and I was dressed and a kind nurse had done my hair and I wasn’t bloody dead.  Given what I had already been through, that felt pretty good to me.