Why You Cannot be Free in a System
By: Dixon Jones
Tags: Vaccines, Nhs, Covid 19, Health, Systems Thinking

In December 2020 I was offroad mountain biking in Aspley Heath near Woburn, UK. Here to be precise. I fell and broke a pelvis.

For the next week, I was in the hands of a well-rehearsed system. The story is in parts very funny. The lessons, though, will affect my approach to life forever.

This is the story…

The Gruesome facts, as recalled on Entonox

Ouch! I was going down a modest (blue) run for my first time, so going TOO SLOW. I got a little muddled, and in braking, I found myself falling to my left. Unfortunately, to my left was another trail, with a two-foot drop. I landed on one straight leg and heard a crunch as the leg decided to explore my nether regions.

Yes, I was wearing a full helmet, arm pads and knee pads. Most of these did not get off until the next morning… not that they were much use with this type of accident!

In agony, I was at least not in danger of being ignored because I was blocking the best trail in the park, and I could not move. I want to say thank you to Dan and other bikers on the scene, both for staying with me and stopping me from getting run over by other cyclists!

I called 111 for a minute, then 999 to avoid the Covid messages, and I am extremely grateful for having the “What 3 Words” app on my phone. That probably saved 10 minutes of admin right there. If you ever go hiking, put the app on your phone BEFORE you leave. The NHS can find you if… for example… you get injured in a wooded trail where no normal stretcher can get to!

Even so, I think it was at least 2 hours before I finally got extracted from the wood. It took three ambulance crews.

The first on the scene included Josh and Aurika, who went to school with my kids! It was about then I realized that I might be too old for mountain bike trails. They took quite a while to arrive because I had first dialled 111 (a non-emergency number in the UK), which had rather affected my place in the emergency hierarchy. This was a problem because I couldn’t move, and the mud was dry but cold, and I knew that moving anything was going to make things worse. By the time they arrived, Dan had found an emergency blanket, and my wife and daughter were with me. At this point, they were not giving me grief.

So — Josh and Aurika sent for the Hazardous Area Response Team, who had to come from Cambridge. Hence the two-hour palaver at the scene.

The best bit about the wait was the Entonox. Laughing gas and oxygen. I do recall shouting at Josh and Aurika when they strapped me to the stretcher. Even in my state, I knew I was an idiot for shouting that they were from the Thought Police trying to take me away! It made me start thinking about how easy it is to lose all sense of reality and how irrational people can get very quickly. More on this in the Philosophy Part but for now I’ll leave one of my many rambling replies to random people here…

So we get to A&E…

So we Get to A&E at around 3:00 PM I would guess. It’s hard to tell when you are as high as a kite. Still, I do recall one conversation with Josh and Aurika (the Ambulance crew) about whether to go to The Luton & Dunstable hospital or the Milton Keynes Hospital. We decided (well… I probably didn’t get a vote… but we decided) to go to Milton Keynes because it was only 7 minutes, not 27 minutes away. I think the overriding reason is that they would have been disciplined if they had not followed protocol. Now I am relatively compos mentis, OF COURSE, you go to the nearest A&E! The ambulance spends less time out of action, and I get treated quicker. At the time, though, I was not so self-aware. Why on earth would I argue that point?

Roundabouts. That’s why. Locals will know. They are bloody painful when your raised leg that hasn’t moved for hours and is cold and held together with a broken pelvis and swings from side to side. Still, They were, of course, right. I also don’t think they were actually from the thought police after all, given that my daughter knew them.

The Gruesome Facts as Recalled on I.V. Paracetamol and Morphine

I ran out of Entonox in the A&E queue. so they happily got me more. Then they gave me the Paracetamol drip and then the morphine. My GOD that stuff is good! Especially whilst STILL on the Entonox.

So now I realize loads of things and nothing. I quite like being in control, and I absolutely was not in control of anything. The system was. I can say that when something is known, then systems get written. Professionals get trained, and the system can do its job. How much do you think a well-rehearsed system should spend listening to a drugged-up guy who, 30 minutes earlier, had suggested his daughter’s school mates were working for the CIA? Not a lot. More on that in the philosophy part too. For now, I did at least realize that nobody was interested in my point of view and so I took to making voice notes so I could remember what was going on in my head.

Listening back, I am really quite glad I was not in charge!

So I spent some time on a stretcher in a corridor, but that was fine I was in an orderly queue of trained paramedics and doctors, and I was glad my chariot turned right just BEFORE the sign saying “Major Injuries”.

Once triaged, I seemed to get an x-ray very quickly, but then was left in a bed bay with a sign on the wall saying “This is a Major Injury bay for serious traumas”. I guess the sign was to stop idiots parking their bicycles in the bay when not used. I am glad nobody did, but perhaps the sign at triage was more of a placebo than I had perhaps foreseen. Then again, I may have forgotten the actual wording.

I stayed there for a while. I felt warmer, safer and sleepier.

The X-Ray revealed a break. Maybe several. So they took me into a CT Scan whilst still in A&E. By then it was just gone 10:00 PM. I know this because they had to request an “after hours” scan. So we are now 10 hours into what was, now, clearly the literal definition of trauma.

Was I rational yet? Well, my biggest concern was not being able to get the Internet or a phone signal. So I would say I was far from thinking rationally. I also knew nothing about pelvic breakages and CT Scanners. I am learning now, though! After the scan they left me temporarily in a “not so serious” bay I think, but there were still nurses and doctors within earshot the whole time. They gave me a sandwich and checked on my pain levels.

I was there whilst they were finding a bed. I finally got to the ward at around 12:30 AM on Sunday. A full 12 hours after the accident. But worrying about waiting times is totally pointless. More in the philosophy part, but every hour that went by I was getting more comfortable and warmer and safer. It made no difference whether I was waiting for a CT Scan in A&E or on Ward 23… in fact, the rational plan (which they knew) was not to put me in the ward until all the vital stuff was done.

And then things got funny.

So here I am in Ward 23 in the early hours of Sunday morning. Now the Internet works great! So my first request to Marie was noise-cancelling headphones, on account of “Alex” shouting all night that his legs had fallen off. They are fine, of course, just dementia, but another example of how little has to go wrong before we lose all perspective — more in the philosophy bit.

I was still wearing three out of four protective pads, my muddy cycling shoes and half of Aspley Heath. I think we got the pads off, but the wood was still there the next day. I really didn’t care. Peeing, however, was starting to become my focus of attention! There was talk of a catheter down in A&E, but fortunately, I was able to avoid that undignified demise. I am SO glad I am a boy. I took to the cardboard bottles like a duck to water. Passing water in bed is more about mind over matter than anything else!

By Sunday proper, I started to get a grip on the important things in life. I had a photo on Facebook; I had a phone charger. I had noise-cancelling headphones. Only now was I starting to be rational. I took everyone’s advice, from the Grumpy old Man group to the nurse that took me from A&E to the ward. TAKE THE MORPHINE. I have been high ever since, except when I chose not to take the morphine. FFS — why did I do that? Deductive reasoning really needs you to listen to the experts. Not that the Grumpy Old Men are experts, but the nurse was.

So in comes the big boss doctors. Specialist in trauma. Now I was told lots of this down in A&E, but the main gist was that the CT scan had to go to Oxford for really REALLY specialized experts to decide whether I needed an operation or not. They believe it to be a complex rami fracture. Whether it is “simple” or “complex” means two very different pathways to getting better! One I should walk on it in a few days… with the other, it is 4–6 weeks without load-bearing and a high chance of an operation.

This is important information, so thank god for technology being able to send the CT scan to the best experts in the land to make the decision, eh?

Well… even experts have to sleep, and it was Sunday now, so because I am stable and because I am certainly going to be bedridden for a while anyway, this was no longer an emergency or even urgent. At last, I was reasoning effectively.

Sunday, Monday and Tuesday have been fun! I won’t lie. I am concerned about Brian, in the bed opposite, who has not stopped staring at me since we arrived. I tried to defuse my paranoia with a little wave on the morning of day 3, and he raised an arm a bit, but as it was still under the sheet, I can’t say whether it was a wave or the finger. Rumour has it (the nurses were chatting to him trying to get him to eat, so it MUST be true, eh?) he is in for falling over whilst starting a brawl in the care home. I probably shouldn’t post his picture up here, but it’s hilarious.

Then there is the chap next to him, who uses the theme tune to Psycho as a ring tone.

By the second night, I had my Bose noise-cancelling headphones, which was great, because I couldn’t hear the guy with his legs on the other side of the room, but terrible when nurse Ratchett made me take them off because they were making it impossible to take my temperature. I argued with one nurse Ratchett successfully that it was just obvious why my temperature was high… but the second was more insistent. Not least because I really DID have a temperature and I should stop being an idiot and do what she says. I did. I was rewarded with more I.V. Parecetomol, a fan and more morphine. I have tried to apologize and thank her, but I think she was rather more senior than most and won’t be back as long as I do what professionals tell me, instead of thinking I know better.

By Monday morning the regular trauma expert came to see me. They had SOME news back from Oxford, but not the critical question as to the pathway they needed to take me down. Nevertheless, I was told that MOSR LIKELY I would avoid an operation but be bedridden for a long time and I definitely could NOT try and walk. On that, I very much agree.

The morphine is great at helping me look at the funny side of life here. However, I DID regress into a little taste of anger when I realized just now that the reason a definitive answer has not come back from John Radcliffe is that “IT” has failed to transfer the file of the CT scan in a way that can be downloaded at the other end. So — they only saw the X-ray, not the 3-D model of what used to be my finest features.

Yep — more about that in the philosophy bit.

The more pressing problem, though HAS just been resolved. Peeing in bed is one thing, but doing a number 2 without stressing your leg or your pelvis is totally something else! There is almost no dignity involved. The first time I tried, Marie decided to Facetime mid strain. That killed it. Then it turns out the downside to morphine in a bedridden world is constipation, So we’ve added laxative to my daily regimen. I cannot tell you how much more rational I feel now I have had a number 2!

The Philosophy Part

During my MBA, I saw multiple papers that — whilst proposing to be about business — inspired their commentary from the NHS or the military. I recall one book… or Harvard Busines Review article… or paper… that reminisced about the author finding himself — or herself — in casualty on a stretcher, thinking about how he was now the sausage in a finely tuned system which was doing its job.

This is what I was trying not to forget to write about as I sat there worse than helpless. I was a novice trying to wield some semblance of power over a situation where I was by far the least qualified to decide anything. If they needed information from me, they asked.

It was doubly poignant because this morning, the Milton Keynes hospital is the first in the region to be doling out vaccines! That’s great, isn’t it? Until I hear from Markos, my duty trainee nurse, that some of the health professionals are choosing not to take it! He and I were both astounded and it may have just been a story on day one of the vaccines rather than the trend, but he did say that the more senior and more (dare I say it) educated the professional, the less likely they were to refuse the vaccine. Basically, the ones that understand the science, the ones that had prepared for this, are taking the vaccine. The only ones that are not are the students! This is a teaching hospital and some have you have really read way too much trash from people that are not professionals or in any way qualified to argue conspiracy theories. Not that any deductive reasoning would lead you to the notion that a pandemic was the best way to be able to track people. They already have phones for that. The phones can also listen to you and my watch even does an ECG and measure my oxygen levels! What far-flung planet are you from if you are that stupid that you’ll let inductive reasoning that you made up yesterday outweigh years and years of deductive understanding that got us great vaccines just in time to save the world and maybe even the pub?

Take your vaccine or die.

(There, I said it. please can quote me as much as you can. I can always just say I was high.)

The NHS and healthcare, in general, is a complex system which, until now, assumes that its participants will at least be rational. Relatively recent understanding of the human brain has helped us understand that we rarely think this way, especially when faced with a threat. I had talked about this before when Trump came to see the Queen, which liberals thought was a bad idea, but reasonable deductive thought processes would say that inviting Trump in was exactly the right thing to do. We are all prone to terrible errors of judgment.

Fortunately, the same failing in the human psyche will also save us. I hear from the outside world that Boris wants us to have vaccine passports. If you have your passport, you can go to the pub! Now THAT will work, in the same way, that I felt the Internet was the most important thing in my life whilst lying down in A&E getting looked after by honest to god professionals.

Here are just SOME of the errors of judgment I have made in the last few days:

Cycling too fast was NOT as dangerous as driving too slow

Wearing padding and helmet will not always protect you in a fall

56 is NOT the new 26

Restraining a patient is not always a bad thing

I should not try and control a situation where I am the least informed in the room

There is a safety reason for roundabouts and a safety reason for NO roundabouts. Blaming roundabouts doesn’t change that

It doesn’t matter HOW MUCH money you throw at the NHS, there will never be a justification for getting more “Hazardous Area Retrieval Teams”. Sometimes things just take a long time.

I do not know better when I say my noise-cancelling headphones are harmless.

In an emergency, dialing 111 first is not helping anyone. I self-selected my Darwinist fate.

[Much of this article was initially written on my personal blog.]