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Paul Sagar, 37, is reader in political theory in the department of political economy at King’s College London. He studied at the universities of Cambridge, Oxford and London and in 2020 received the British and Irish Association for Political Thought early career award for excellence in research and teaching. A once passionate rock climber, he suffered a catastrophic accident last year while climbing in Scotland. The accident left him tetraplegic, paralysed from the collarbones down, with only residual use of his hands. After eight months in hospital, he resumed academic work in early 2024, continuing physical rehabilitation and attempting to adjust to life with severe disability. This is an extract from his diary of the past 16 months.
22 August 2023
On 5 June, I was climbing in Glencoe with a friend. Because of friability in the rock, a route we had thought to be in unusually safe condition turned out to be almost lethal. On the final pitch, as I was leading, the rock collapsed and much of my gear exploded out of the placements. I fell about 20 metres. My left arm was shattered severely, and my right arm was also broken, albeit less badly. Worst of all I fractured two vertebrae in my neck.
Luckily, I was climbing with a surgeon that day and through amazing good fortune and his incredible skill and composure, he saved my life. I was airlifted to Glasgow hospital where I had several operations and awoke four weeks later. After a period of drug-induced insanity I eventually came to something like my senses. Since then, I have been transferred to the Royal London hospital, where I am undergoing the start of a very long physio journey.
At present, I have limited use of my hands and no control of my body below my abdominal muscles. This is not exactly how I planned to spend my summer, to say the least.
I have written this short post using voice dictation software, partly just to prove to myself that I can. The likelihood is I will never walk again, let alone climb.
1 September
If I had to pick the single worst thing about living in hospital, there would be some stiff competition. There is the constant disruption, having no control over when I wake up, with people barging into the room at whatever time suits them to jab me with needles or slam bin lids. There is the total dependency on others to complete the most mundane of tasks, be it feeding myself or getting my teeth brushed. There is the infuriating frequency with which staff will talk about me when I’m in the room, or ask each other questions that I know the answers to, but which they do not bother to consult me about because the default assumption is that the patient is clueless.
However, the number one worst thing about being an early stage spinal injury patient in hospital is, for me at least, the daily humiliation. You see, an aspect of spinal injury I wasn’t aware of until it happened to me is that it’s not just that you lose the ability to use your legs and possibly your hands . You also lose functional control of your bowels and bladder.
Hence this week I underwent a minor surgery to drill a tube directly into my bladder, making my penis effectively redundant. I have anyway by now lost count of the number of strangers who have either seen or had to wash my genitals.
11 September
Who am I? It’s hard to be sure any more. In recent days I have found it harder and harder to shake the feeling that I am an impostor. Increasingly I am struck with the sense that somebody did die that day in early June. I share his name, his legal details, his date of birth, and even his memories. Other people seem to think that I am him. But I am increasingly unsure. I look at the arms attached to me now, and they are thin like twigs. Forearms have disappeared completely, while biceps are a rump of what once was. When I have glanced at my chest during occasions of being washed, I am astounded to see that it simply no longer exists. There is just flat bone above visible ribs. When attempting to do the most basic of exercises, a mind that remembers developing serious core strength over years tries to engage abdominal muscles that cannot perform even the beginning of a single measly sit-up. And then, of course, there are the hands that barely function and the legs that do not move at all. The person who woke up on 5 June looked and felt absolutely nothing like this.
Somebody died that day, and somebody different survived. I am the survivor, playing the role once held by a dead man, and every day slightly puzzled as to why nobody seems to have noticed the switch.
1 October
I am now in the rehab department at the Royal National Orthopaedic hospital at Stanmore, Middlesex.
Conversation matters. It distracts me from my situation and connects me to a world beyond my circular thoughts. But it’s also risky. Topics that ought to be safe are, for me, not necessarily so.
Take the weather. Comments on the unseasonable warmth we’re having are tough for me to hear. Yes, it means I can visit the rehab centre gardens. On the other hand, I immediately think of how I’m not out climbing in such perfect weekend conditions. And never will be again.
Many remarks can trigger pain without the other person meaning to, or even realising. Take the friendly Irish nurse who tonight told me of her love of hiking in the Peak District, her trips to the Lake District, her walks in Switzerland. It took all my strength not to reply you have no fucking idea. I didn’t just hike those places. I saw and accessed sights you can’t even imagine. And then my mind is flooded with all the places I’ll never see again. The North London Mountaineering Club hut in Snowdonia, my home from home that I planned to visit regularly until I died. Wen Zawn at Gogarth. My favourite Kalymnos bar. Portland sport routes. The Borrowdale trad crags. The view of Italy from 3,000m. The feeling of slinging a full rucksack back into the van after a long day’s effort. Wyoming. El Chorro. Fontainebleau. Never again. And the list goes on.
It might sound strange but the emotion I feel in relation to this is heartbreak. I realised this today after a kind nursing assistant asked me (respectfully, in appropriate circumstances) what my accident had been. I told her the story. And then I began to cry. A 36-year-old man in tears, in front of a near stranger.
5 October
The truth is I’m finding rehab very hard. After spending nearly three months fixating on getting here, the reality of starting intensive physio and therapy is not the instant salvation I had hoped it would be.
The rehab team gave me a power wheelchair this week, which restores a modicum of independence. All I can think about, however, is how small the rehab centre is, having now lapped it dozens of times. And about how winter will soon make even the gardens inaccessible. And this is where I will spend every day for months. The other night we were lucky enough to listen to music performed live in the large outdoor pod. Upbeat songs about love and joy? They just make me think about how I don’t have a partner, I don’t have children, and I’ve realistically blown any chance at either from here on out. So what is left to give the fight meaning? What’s the point?
19 October
I am no longer the only published author among the patients at rehab. Indeed, I’m not even close to being the most widely read any more. That’s because a couple of weeks ago Hanif Kureishi arrived to also undergo rehabilitation. As well as being a successful novelist and screenwriter, Hanif directly inspired me to start these blogs. That’s because he has been dictating Substack posts via his partner and children since he suffered a debilitating spinal cord injury himself on Boxing Day last year. I was made aware of his regular “dispatches” while in Royal London hospital, and read all of them. It was helpful to hear what somebody else going through the same kind of experience as me was making of it, and it brought me solace when he wrote about struggling with some of the same things that I have. More generally it made me think that if he could write, then I should try writing too. And so I did.
Hanif and I have had a couple of good conversations since he arrived, but nothing is ever easy in this new life and he is now mostly isolated for infection control reasons.
3 December
I’ve written before about how utterly overwhelming this experience is. Well it turns out that it doesn’t get easier with time. I didn’t realise one could be overwhelmed by constantly feeling overwhelmed. Overwhelm fatigue. Metawhelmed, if you like. That’s where I’m at right now. My mind is a cacophony of paradoxical, or at least incoherent, thoughts.
Here’s an example. Last week was my “case conference”, when the therapists and medical leads here sat down with my parents and I to discuss my progress to date, and future steps. They congratulated me on having made real gains as a result of trying very hard in my various physio and therapy sessions, and therefore extending my admission by another month. This is only done for people who have made progress and whom it is believed will make further gains if they stay longer. By no means does everyone get extended.
Great news for me, right? Of course I can see that this is ultimately positive. My parents were a little baffled, however, as to why I nonetheless apparently took so little cheer from it. The answer is that I find it hard to be uplifted by progress towards a goal that I fundamentally don’t want. The brute truth is that I don’t want to be a better-than-expected tetraplegic. I want to be an able-bodied man with his life back. And the fact this is impossible doesn’t stop me wanting it.
26 January 2024
If nothing else, the past half a year has made me acutely aware of how dependent on family one becomes even while living in the heart of the NHS. If it weren’t for my mother and father, I would be truly screwed. It would have been impossible for me to single-handedly deal with things like securing accommodation for the future, let alone communicating with my employer and various crucial organisations during the first few months of my injury. As far as I can tell, after an accident like mine, those who don’t have family to pick up the pieces are in the direst of dire straits.
So I’m lucky to have parents who care enough, and are competent enough and financially stable enough, to offer me serious help in rebuilding something like a life. And for this, of course, I am grateful. Which leads to a question: why then do I sometimes behave like such a shit?
Last weekend was not my finest hour. Having made the long trek down from Merseyside to the rehab centre just outside Watford, my mum and dad came to spend time with me. And I rewarded them with toddler levels of truculence and incivility. Why can’t I behave nicely, as a fitting display of the gratitude that I do genuinely feel towards them?
The answer I think lies, at least in part, in the fact that half a year ago I was an independent adult with his own income, career, projects, and so forth, but I am now effectively reduced to the status of a child. I need Mummy and Daddy to help me with everything in life. And this is a very difficult thing to come to terms with. And if one is now living like a baby, why not act like one?
Add to that the fact that I’m now in the position of having to be grateful all the time: to the person that wipes my arse, to whoever washes me, or puts my clothes on or brushes my teeth. I am grateful to the person that brings my lunch out and puts it in front of me, to the nurse who puts my afternoon medication into my mouth. I am grateful to the staff in the gym that I spend most of the day with, most of whom by now have had to cope with either my piss or shit at least once. I am grateful to whichever persons put me to bed before propping up my iPad so that I can watch some crap on Netflix before falling asleep and repeating it all again.
The result of this is what one might call gratitude exhaustion.
5 February
One of the many things that I never appreciated about my old life is that I was virtually never bored. My work consisted mostly of reading and discussing interesting ideas with colleagues and students. If I got bored during the day, I’d amuse myself by playing online chess (poorly). I trained for climbing 10 to 15 hours a week, while weekends were almost always spent driving somewhere it wasn’t raining so as to climb outdoors.
Evenings after training left time for good-quality TV, or reading a novel. And of course there were always friends to catch up with in London if I ever felt like actually being sociable. Failing that, I’d go fishing. Essentially, if I was awake I was active, either in body or mind. A lazy weekend, doing nothing, was something like my idea of a bad time.
The contrast with my new life could hardly be more stark. I now regularly spend chunks of time just doing nothing.
The strangest thing, though, is how accustomed I have become to this mode of living. Seconds become minutes, become hours, become days. Time just drifts by unfilled, and I watch as it passes. I’m bored, but weirdly indifferent about that boredom. It doesn’t drive me crazy like it would have before. I’ve become somebody else; somebody I don’t especially admire, but who seems worryingly like they are here to stay.
10 March
I have now moved on to a nursing home. There is no doubt that it is an improvement on living behind a curtain in a hospital ward. Nonetheless, I have the sense of starring in my own personal Groundhog Day. Every day is basically the same. Mornings are lost, waiting for my various needs to be dealt with. Afternoons I spend trying to work, with decreasing levels of enthusiasm. Evenings I play some online chess, wondering how it is possible to get progressively worse as the days pass. Then it is back to bed for yet more TV. Rinse, repeat. I never go anywhere new. I have no plans. There are no holidays to look forward to. No weekends away. Just more of the same, day after day. Bill Murray, I get it now.
And so it might not be especially surprising to hear that I am not doing very well psychologically. Leaving the hell of rehab, getting some minimal privacy, and being able to read serious work for the first time in months gave me an initial mental boost. But it is not especially surprising that this was not a magic cure. And yet I am still taken aback by the scale of my mental collapse. I feel as hopeless, as unable to accept and adapt, as at any other time since I regained consciousness. For a few weeks, I genuinely thought I was getting better. I do not feel even remotely close to that any more.
All of which has led me to a decision. I have begun the process of formally applying to Dignitas, with the eventual possibility of assisted suicide. Many more steps will be required if I am ultimately to go through with this, and I will have the option of changing my mind at many points in the future. (Some people have tried to tell me that I will not be eligible because I am not terminally ill, but I have done my research and although there is no guarantee that I will be accepted for consideration, tetraplegics from Britain have used the Swiss service before.) At the very least, what this gives me is the psychological comfort of knowing there is an escape route. I am so tired of feeling completely trapped, forced to stay alive by other people, with all the power and control removed from my own life. Even if I don’t take the option, knowing that the option is at least there provides a kind of comfort: the knowledge that I still have a final small amount of meaningful agency, that I can finally make this stop if I want to.
11 May
Last week I completed the long process of losing my home. The apartment I lived in for three years has changed hands, and now belongs to somebody else. And it hurts so much.
The place was very modest; just a small one-bedroom flat. But it was mine. Those were my bookshelves. My choices of mountainscape on the wall. My arrangement of furniture. My base of operations for work, whenever I wasn’t travelling, trying to get as much time in the great outdoors as I could. Shortly before my accident, as a way of channelling the emotional pain from the breakup of a four-year relationship I had repainted most of the walls and doors, even had a new carpet fitted in the bedroom. And then one day I walked out and drove away, not knowing that it was for the last time. Nobody told me that I would never see the place again. I never got to say goodbye.
5 June
It has been a year to the day since my accident. A year since I woke up somewhere peaceful, somewhere quiet, at a time of my own choosing. Since it was up to me alone how long I stayed in bed. A year since I could piss standing up, of my own volition, rather than it dribbling out of me into a plastic bag. A year since I made my own breakfast. Since I was able to lift a normal cup of coffee. A year since I was able to drive, often hundreds of miles at a time, just to be outdoors and in the wild.
Far more than a year since I held a woman’s hand, felt the touch of a human body against mine. But a year since these things were even possible for me; something that could sanely be hoped for some future day. A year since it was physically possible for me to enjoy exercise, or use it as a weapon against the parasite of depression that now resides in regal ascendancy over my mind. A year since I climbed. That indescribable world of adventure, which gave my life satisfaction and meaning. The antidote to the psychological ill-health that an academic career made me otherwise so especially vulnerable to.
A year since I woke up even just indifferent about, let alone looking forward to, the day ahead. A year since my first thought hasn’t been wishing that I had died in the night. A year since I felt more than fleeting moments of happiness. A year since I felt joy.
A year since I died.
A year since I was reborn into a life I never agreed to, and would never have chosen, but am condemned by others to continue. A lot can change in a year. And so perhaps, out of the darkness, comes also the light of hope.
18 June
Through the herculean efforts of my parents, I now have a new place to call my own. And making the adjustment has been perhaps the most difficult thing I have been through so far.
I really didn’t think it would be this way. While nervous, before the date of the move I experienced a definite uptick in mood. This began to fade once we pulled on to the North Circular. Here was a route I had driven many times in my old life. The store where I bought furniture for my first apartment. The pet shop where I sometimes got supplies for the cats (that I no longer have). The turning I used to take to the Lea Valley to fish for pike in the winter. When I last saw these places, I was driving my own van. Now I was in the back of an ambulance, being awkwardly jolted around. Memories came flooding back punching me in the gut, reminding me how much I have lost.
My mum came down to meet the ambulance crew and help transfer me and my possessions up into the new flat.
One thing stopping this apartment from feeling like a home is that the walls are all bare. The answer to which would normally be obvious and easy: hang up my own pictures. But there’s the rub. Hanging any of my old artwork on the walls is almost too painful to contemplate, not least because a lot of it consists of framed pictures of mountains. Mountains that I have climbed. Even non-climbing artwork inevitably comes with memories of previous homes it has hung in; past times in my past life; friends in happier years.
But pictures were by no means the worst of it. Also transported from my old home to my new were my old clothes. The problem is that now I can’t wear most of them. All of my old jeans, and anything with a button or a buckle, now poses the threat of pressure sores. When it comes to upper layers, anything snug against my former physique is now impossible to combine with the repulsive potbelly I permanently sport. So I agreed to help my mum triage my old clothes, deciding what to keep and what to throw away.
I don’t think I’m exaggerating when I say this is the most painful thing I’ve ever had to do. Virtually every piece of clothing had some connection to my former life: climbing gear, bouldering gym merch, T-shirts from climbing destinations, outdoor brands – aside from the odd Guns N’ Roses T-shirt, almost every item put a dagger through my heart. Or rather, two daggers. One for myself, who died. One for climbing, the love I lost.
7 August
It’s been a while, and enough people have been in contact in various ways, asking if I’m all right, that I feel a quick update is in order. In the grand scheme of things, yes. On the physical side, putting aside for now that my body is a wreckage site that will only get worse with time, I’m doing OK. No further complications, with UTIs and spasms under control, for once.
On the mental side, well… it’s a process. My occupational therapist in rehab told me that most people find the first three to six months after leaving hospital the hardest. My physical therapist said I should expect the first year to be “hell”. So far, I can’t argue with that. I’ve been able to distract myself with academic research and writing, which is certainly more than nothing. But it’s hard to feel like it’s enough.
25 October
I have been watching the debate over changing the UK’s law on assisted dying with sardonic interest. On the face of it the debate should have nothing to do with me. I, after all, am not terminally ill, and what is being debated is whether people with six months or less to live should be able to die by suicide with medical help. I simply don’t meet the criteria. However, those who oppose a change in the law often claim that if the law is loosened, we will be on a slippery slope down to a place where people like me (disabled people) are not only offered assisted suicide, but pressed by wider society into taking that option. And as this would be bad, the law should stay as it is. On the other side, those who favour changing the law vigorously deny (at least in public) that any such slippery slope will be encountered – and thus they implicitly or explicitly agree that assisted suicide should only be for those who, to put it bluntly, are going to die soon anyway. Hence, again, it is not for me. The effect of which is to compound my overwhelming sense that I am trapped in a living nightmare from which I cannot escape.
When medical professionals decided that my ruined body should live, whether I might have wanted it to or not, they also determined that any future choice about whether to continue would for ever be taken away from me. Whereas a normal-bodied (or even just less disabled) person could take matters into their own hands and decide that enough is enough, I cannot. I need the help of someone else. And the law is pretty clear that nobody is allowed to help me. Hence, trapped. The potential loophole here is of course to go abroad, to a jurisdiction where medically assisted suicide is legal. And so, I’m working on it. The application to Dignitas is active.
11 November
In ancient Greek mythology, Pandora is said to have unleashed a range of curses upon humankind. Curiosity led her to open a box entrusted to her husband, out of which death, sickness and a host of other evils escaped. But left behind, so the story goes, was hope.
One way to read this is as a sort of consolation. That despite all the evils humanity is forced to endure, we are able to cling to the light of hope. But I’ve long suspected (both before my accident, and especially since) that hope is the worst curse of them all.
Moral philosophers like Adam Smith would rightly point out that being in a wheelchair, with virtually useless hands, is not a permanent obstacle to mental tranquillity. Plenty of happy tetraplegics prove it to be so (and indeed, I have met some of them). If I first accept my situation, and allow my psychology to adjust to it, it should be possible to escape the pit of despair.
But I am consumed by a hope that holds me back. This comes in the form of longing for medical and technological advances that somehow “cure” spinal cord injury. This is indulged by regular Google searches along those lines. Like the other night, when I went down the rabbit hole of investigating NVG-291, the leading candidate for a therapeutic treatment, now in phase 1b/2a human trials. Riding the high of hope, I convince myself that I’m only going to have to do this for a few years, and then I’m going to get my life back. But then the hope wears off, and reality hits: that even if it lives up to the most optimistic hopes, NVG-291 is only going to restore partial functions, and will anyway take years to arrive in a clinically administered setting. And even if it does arrive, I am not getting my old life back, because that life is now definitively over.
As the saying goes, it’s the hope that kills you. My hope is a curse. I need it to die. I need to accept.
Maybe tomorrow.
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Read Paul Sagar’s Substack, Diary of a Punter, here
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