Bicycle crash victim Rachel Burrows talks to Richard McComb about how she miraculously survived crashing her bicyle head first into a tree.

Immobilised with a broken back and staring at the ceiling of a spinal injuries unit, Rachel Burrows started to tot up the number of health service workers who had cared for her.

She quickly ran out of fingers and eventually got to 106. The number did not include the nine volunteers who also did their bit to help put her back together again.

Then Rachel’s mind started to dwell on other aspects of life on the ward and odd details sprung to light – like the fact that she had worn 40 different NHS standard issue hospital gowns (in four different designs) and had eaten 111 hospital meals.

Rachel started the list, recording some of the weird and wonderful facts about her treatment, after she broke her back in a cycling accident near her home in south Birmingham. Medics said she could have died if she had not been wearing a cycling helmet, bought for £80.

She was transferred to the Midlands Centre for Spinal Injuries in Oswestry, Shropshire, after being treated in the aftermath of the crash at Birmingham’s Selly Oak and Queen Elizabeth hospitals. And it was here that Rachel’s natural instincts as a gatherer and disseminator of information took over.

As the head of communications at Birmingham University, she was used to collating the minutiae of budgets, research papers and PR campaigns and decided to analyse her own predicament in a lively patient blog.

Her hospital stay happened to coincide with an attack by US Republicans on the NHS. It was the right-wingers’ way of rubbishing Barack Obama’s plans for health care reform and Rachel felt moved to hit back in defence of the NHS – from her hospital bed on the Welsh borders.

“I couldn’t fault the care I had. I had a very thorough and well-rounded experience from the accident to being signed off within the last month,” says Rachel, who went on to make a full recovery.

The 36-year-old wanted to highlight the “amazing range of services and care” provided by the NHS but then “silly ideas for counting certain things popped into my head during my days of bedrest.”

Days turned to weeks and the list lengthened.

The calculation about the number of NHS professionals who treated her is remarkable, illustrating the expertise and sheer manpower required to care for a seriously-ill patient.

The total of 106 comprises: paramedics (3); ambulance drivers (3); patient transport (2); consultants (4); doctors (5); healthcare assistants (20); matrons (2); sisters (5); nurses (17); physiotherapists (7); occupational therapist (1); psychologist (1); plastercast fitters (3); hospital porters (15); GP (1); orthotics specialist (1); radiographers (15); medical photographer (1).

To this can be added nine volunteers and pastoral supporters, namely: Red Cross volunteers, who provide weekly manicures on the ward (2); RJAH volunteers operating a library trolley, newspaper/magazine trolley, and putting flowers on the wards (5); and clergy (2), both a Roman Catholic priest and a member of the Anglican clergy.

Other facts about Rachel’s treatment include:
*?Hours spent in hospital – 894
*?Types of medical imagery captured – 4 (x-rays, CT scans, MRI scans, photographs)
*?Number of medical images taken of injuries – 35
*?Mobility aids issued – 2 (helping hand litter-picker and a long-handled shoe horn).

Then there is what Rachel calls the “fun stuff” at the unit, which is part of the Robert Jones & Agnes Hunt Orthopaedic Hospital. These are:
*?Number of days without a shower: 85 (32 before cast was fitted, 53 before removal)
* ?Bouquets received: 14
* Episodes of The West Wing watched: 101.

She also recorded an amusing list of quotes “from behind the hospital curtain” which she amassed on her blog. These included:
* “Ooh, your calves have got ever so soft and flabby since you’ve been on bedrest”
* “Is that you on that photo? I didn’t recognise you”
* “Are you a paraplegic?”

Rachel says her sense of humour – and her mildly obsessive attachment to making lists – helped her to get through the traumatic experience. She remains in no doubt about the quality of the care she received from the NHS and the value of wearing a cycling helmet.

As A&E doctors initially worked on her at Selly Oak Hospital, the consultant walked into the waiting area to talk to her husband, Adrian.

The medic was carrying the smashed cycling helmet Rachel had been wearing when she crashed head-first into a tree on a country lane. The trauma team had been studying the headgear to see if it would reveal clues about the point of impact and highlight any possible areas of brain injury.

“The consultant came out to give my husband the helmet and he said, ‘That has just saved your wife’s life’,” Rachel says.

The helmet is on a table in a meeting room where I meet Rachel. She picks it up to show me the splits and cracks, testament to the jolting, 30mph impact with the tree.

Rachel and Adrian were nearing the end of a 25-mile training ride on May 9 when they took a right-handed downhill bend just half a mile from their home in Bartley Green.

Rachel recalls: “I knew I didn’t have the right line. I knew I was potentially going to crash, but I didn’t know how spectacular it would be.

“I remember going towards the grass verge but I don’t remember what happened next. I woke up on the floor and wanted to get up. I didn’t think I had done that much damage.”

In fact, she had broken her back and 35-year-old Adrian’s quick actions undoubtedly stopped her from aggravating the injury. Having flown over her handle bars and struck the tree, she had rolled back towards the road. Adrian told his wife to lie still and made sure oncoming traffic was aware of the crash scene.

Rachel describes her childhood sweetheart – they met when they were 14 – as “my hero”.

She says: “In a short space of time he was doing traffic control, wife control and giving medical assistance.”

Over the course of our interview, Rachel is fulsome in her praise of all the medical teams and individual health workers. But the fact remains that all of their efforts would have counted for nothing – indeed they may have been unnecessary – had it not been for the silver and red Las cycling helmet that Rachel bought a few years ago.

She could have bought a cheaper one, for 30 or 40 quid, but chose the £80 model because it was a comfortable fit. It turned out to be the best investment of her life. She recently wrote to the manufacturer of the helmet, which was ripped from her head by the impact, saying: “Thank you for saving my life.”

“I could have died,” Rachel tells me. “I feel that my helmet either saved my life or saved me from a very different life.

“If I had gone into that tree at 30mph without a helmet ... A blow to the head at that speed ...” Her thoughts drift temporarily. It is almost seven months since the accident and it is clear that her emotions are still raw, despite Rachel’s good-humour and eloquent demeanour.

Collecting herself, she says: “I have no brain injury, no paralysis and I am alive to tell the tale. I am very lucky.”

Rachel’s experience means she has become a vocal advocate for the wearing of cycling helmets. She is incensed when she sees people riding their bikes without head protection. “They say it isn’t cool to wear a helmet,” says Rachel, exasperated. “What are they going on about? What’s being cool got to do with it?

“On campus the other day I saw a student cycling down a hill without a helmet on – and he was talking on his mobile phone at the same time. Unbelievable. I could have screamed.”

Her own accident, she says, was down to human error, but she makes the point that people make mistakes all the time.

Her message is: don’t think it won’t happen to you. Then there are all the other factors that cannot be controlled, such as cars appearing out of side roads or driveways. “I’ve had pheasants run in front of me before during rides in the country,” says Rachel.

But if she is vociferous about the importance of wearing cycling helmets, she is equally passionate about the conservative management of spinal injuries.

Although surgical intervention is often seen as a quick-fix, and cheaper, solution to back injuries such as Rachel’s, there is another school of thought that suggests the body is equally good, in some cases better, at mending itself. All it needs is time, plenty of it.

Rachel was transferred from Birmingham to the Midlands Centre for Spinal Injuries five days after her crash. Exhaustive X-rays and CT and MRI scans had helped to diagnose that she had suffered a triple fracture to her L1 lumbar vertebrae.

The nature of the break meant her spinal cord was in a vulnerable position. The vertebrae effectively had been “pancaked” flat by the shock of the head impact. There were also assorted open wounds and severe bruising, but the broken back – and the technique for repairing it – was the overriding concern.

The options were spelled out for her by spinal injuries consultant Wagih Shafik El Masry, who has a clinical interest in spinal cord recovery following trauma.

A former chairman of the British Association of Spinal Cord Injury Specialists, Mr El Masry laid out the cold facts (recovery times, success rates and risks) of both surgery and conservative care. He did so without any bias, says Rachel, who admits she was terrified by the prospect of going under the knife.

“The thought of a surgeon operating on unstable fractures around my spinal column was too much to bear, especially knowing that they’d probably have to go in from the front and the back,” says Rachel, “and given that at that stage, although I was immobile, I was intact and almost in full control of my faculties.”

A surgical procedure meant the recovery time would be far quicker and she could be home in a fortnight. Statistically, the operation had a 98 per cent success rate.

Rachel, though, was frightened of falling into the two per cent failure category and feared waking from the anaesthetic to discover she was paralysed.

In contrast, the conservative care system involves two main stages of recovery: four to six weeks of total bedrest in hospital, followed by six to eight weeks in a plastercast jacket, which is worn at home following discharge.

Rachel says: “For me, three months of my life for stages 1 and 2 of recovery was nothing compared with knowing that I’d walk again for the rest of my life.

“Conservative care is slower but has 100 per cent success rate. I now know that around 90 per cent of people who are given that choice take the same route.”

She thought she could cope mentally with being immobile for several weeks. A new mobile phone allowed her to communicate via text, Twitter and the internet with the outside world. She also started writing her blog and indulging in her spectacular NHS statistic-gathering.

Rachel is delighted that she followed the option of conservative care and believes, as does her consultant, that she has made a better longer-term recovery and will have a greater range of movement than if she had had the fractures pinned during surgery.

In fact, her recovery has gone so well that she has agreed to become a pin-up girl – for conservative care and has been filmed carrying out various physical tasks, with the video being shown to medics as an object lesson in the benefits of leaving the body to heal itself.

“I have had to sign my model release forms so they can use the photos and X-rays and videos of me,” says Rachel. “My modelling career has started. It is quite a niche but it’s coming soon to a medical conference near you.”