Being paralysed in a freak accident made me a better doctor

Telegraph

22-05-2025

The news report, published on the evening of 17 October 2018, is perfunctory. 'Emergency services were called to Westfield Shopping Centre in Stratford at about 16:00 BST after reports a man had fallen and a woman was injured.' There is a quote from an eyewitness, who describes seeing 'a man mid-air', and an assurance from the Metropolitan Police that the two people in question are not in grave danger. 'Both remain in hospital, but their conditions are not thought to be life-threatening.'
You only have to glance at the grainy photograph illustrating the story, ripped from the Twitter feed of an onlooker, to know that can't possibly be the whole story.
Grace Spence Green woke up on the floor. She wondered how that could be, given she hadn't fallen asleep. She had just said goodbye to her friend and begun walking through the shopping centre in the direction of the Tube, on her way to teach a children's climbing class. Now, she was staring at the bright white ceiling, as if her brain had experienced a computer reset.
Three things occurred to her. The first: she was screaming. The second: there was a figure lying on the ground near her. The third: she couldn't feel her legs. A crowd was standing around her, while another stood around the person next to her. 'They were telling him that he had fallen, and they weren't telling me that.'
Spence Green pieced together that the man must have fallen on her. After that, her memory becomes patchy. It flits from the moment she woke up, to the ambulance, to the cold, hard bed in Royal London Hospital's A&E, where she remembers feeling high on morphine and having little idea of what had transpired. 'I felt like I was talking really fast [and] loud like I was drunk, and everyone around me was completely sober.' She recalls being in a blind panic that the friend who had rushed to the hospital must be put in a taxi home, telling her mother: 'We have to call her an Uber, she can't be walking around late at night after this.'
Now, that first night comes to her in snapshots; she still finds it difficult to return to them. 'I really struggle with this moment. I find it harder to consider – even more than being in Westfield. I [felt] completely out of control then… It felt like I didn't know what had happened to me; everyone else around me did. I didn't know what was happening inside [me]; all the doctors did. I didn't know what was going to happen next.'
In To Exist As I Am, the book Spence Green has written about that day and the many ways her life changed in its aftermath, she explains: 'I would rather not know the extent of my oblivion that night.'
What came before the oblivion was a stroke of sheer, random bad luck. Walking across the Westfield concourse, Spence Green broke the fall of a man who had just launched himself off the top floor. The man – who, it was later concluded, was probably under the influence of cannabis at the time – had been searching for a place to jump. Psychological evaluation would determine that he hadn't been attempting suicide. In court, where was sentenced to four years in prison, a judge said any psychotic symptoms he might have been experiencing were due to 'voluntary consumption of cannabis rather than any underlying mental disorder'. He came away with a fractured leg; Spence Green was paralysed from the chest down.
She was taken to surgery. Later, she would learn that the surgeons had to stop midway through the operation and ask for her parents' consent to cut into the base of her skull, to check whether the fractured bone at the top of her neck needed to be bolted in place. 'Sometimes,' she writes in the book, 'late at night, I imagine myself, face down, layers of skin and fat and muscle splayed out to reveal my bones, waiting for the operation to restart.'
For the first three days, Spence Green still didn't know the extent of her injury. Her parents, both university professors, and boyfriend Nathan, then a physics student, sat vigil by her bedside. She hadn't yet seen the long line of stitches running down her back. 'The thing I remember most is after my surgery, there was this really annoying nurse specialist who would come in who was so chatty all the time. I remember asking her about walking again and she didn't say anything. That was the first sign. Even then, it was hard to consider that.'
It wasn't until day four, when the surgeon came to see her, that she reached down to feel her leg. 'He was explaining my diagnosis; a T4/T5 spinal cord injury,' she writes. 'Paralysis just below my breastbone. I remember daring to put my right hand under the bedsheet while he was talking to touch my thigh, and shuddering. It was unreal. Feeling my leg and not feeling my hand back.'
In the book, she explains that it was as if her legs 'had been lost in an abyss of crushed nerves'. They were 'constantly vibrating'. 'They now stretched on for miles, an infinite void of static between my chest and my feet, which I was only beginning to make the fuzzy outline of.'
It didn't help, she says, that it was 'a completely bloodless injury'. Unless you saw the stitches, there was no evidence of what had happened to her. The hospital admission notes state: 'no obvious external injuries identified'. 'Maybe if I looked down and I was bruised, my brain could understand a bit more, but I couldn't relate to the long line going down my back. I don't remember the impact. When I looked down I looked the same, and it was really hard to bridge that vast gap.'
The recovery plan seemed a foregone conclusion, the expectation (from herself, from loved ones, from strangers, from certain medical professionals) being that she would go to a spinal rehab centre, work very hard and learn to walk again. 'It's so interesting what you fall into, the narrative of, 'OK, this has happened, but I'm going to be like people I've seen on TV. I'm going to walk out triumphantly at the end and do the recovery montage,' because I guess that's all I'd seen.'
When she eventually moved to the London Spinal Cord Injury Centre, at the Royal National Orthopaedic Hospital in Stanmore, the specialists there were more realistic. Brutally so, at times. 'They said, 'It's very unlikely you'll walk again.' At the time I was like, 'I'm going to prove you wrong.'' It was a 'strange environment'. Most patients were 30 years older than her, 'lots of them really struggling to cope… And a lot of them walking or starting to walk before me. There was a real competitiveness with some people.'
Looking for inspiration online, she found only stories of people striving to walk and succeeding. She remembers feeling, 'that's my whole life now – just trying to get back to standing'.
But she wasn't just trying 'to get back to standing', she was, quite understandably, trying to get back to her life. At the time of her injury, Spence Green was a fourth-year medical student at King's College London. 'My mum remembers on day two or three I woke up in HDU [a high-dependency unit] and said, 'Do you think I can still be a doctor?''
Medicine hadn't always come easy, but before the accident she had been beginning to feel that her hard work was paying off. She felt more sure of herself in her studies and, at 22, in life. 'I felt like I was figuring out the outlines of myself,' she says. On that day in Westfield, it was as if everything that had been taking shape disappeared in an instant. 'Suddenly there was no path in front of me, it was just blank.'
In the first year after her injury, Spence Green had to learn how to navigate the world as a wheelchair user. She had to relearn how to do everyday things – get dressed, take a shower, make something to eat. Early trips to meet friends and attempts to return to her life were often fraught with difficulty. 'I'd go somewhere where there wasn't an accessible toilet and I wouldn't ask, so I'd just be desperate to pee the whole time.' She was shocked by how her right to privacy seemed to have been taken from her. 'And how intrusive people are… I couldn't believe how weird people were after my injury and how people struggled to interact with me.'
Returning to medical school, she felt conspicuous. She hadn't found many examples online of wheelchair-using doctors. 'I remember going into a lecture and dropping a pen and being so terrified that I might not be able to pick it up or wouldn't pick it up right. It's really interesting how self-conscious I was then. Not wanting to draw attention – more attention – to myself.'
Eventually, she knew something had to change. 'I just thought, 'Actually, this is not sustainable, any of this; I can't live like this.'' The first, important step was to abandon the goal of walking again. The second involved setting some firm boundaries. 'Before my injury I didn't want to make a fuss ever, I didn't want to confront [anyone]. And I thought, 'I actually can't do that now.''
At work, she found her way through, navigating ironically inaccessible hospital wards and consultants with egos who often made it clear she wasn't welcome. But while the environment wasn't always easy to manage, something about the fact that she presents as being slightly different proved helpful when interacting with patients. 'The hierarchy dissolved because I was physically at their eye level. It's just so obvious that I've either been the patient for a bit or that something has happened to me. I felt there was this trust I didn't have to build already in place. I was really surprised by how powerful that was.
'I think that really gave me confidence to advocate for patients. It made me realise I know more than some of my senior colleagues.'
These days, as a resident doctor about to start paediatrics training, she considers her difference to be 'such a gift' when it comes to her job. More than anything, she is determined to make sure patients never feel victimised by their treatment, as she often felt. And she insists on maintaining their dignity. She wants them to leave with 'their sense of self intact'. 'That is our purpose,' she writes. 'To make the horrifying as bearable as possible.'
You don't have to spend much time with Spence Green to see she is going to be a wonderful children's doctor. We are talking at the kitchen table of the flat in north London that she shares with Nathan. The pair have been together since they met at university. At the time of the injury, they were living with friends on a ramshackle houseboat by Tower Bridge. That they would stay together and weather the considerable storm thrown in their path was never in question.
'Something like this really makes or breaks a relationship, and I think it made ours,' she says. 'You have quite difficult conversations early on that maybe you wouldn't have. He's such a constant. It's all I needed in hospital. I remember waking up and thinking, 'What if he's not here for this?' But he just was there, every day. Constantly there. And that was the huge thing.
'He has been asked a couple of times – I remember by a friend – 'Are you going to stay?' It wasn't even an option not to stay. It happened to both of us.'
Seven years on, there is more give and take to the balance of care in their relationship than some people might assume. In the book, she writes about how, if someone were to see them together – she in her wheelchair, Nathan opening a door for her – they might feel they had the measure of them. 'I doubt that most see me as an equal member of the relationship. Even if I am telling him where to go, paying for the meal at the restaurant, supporting him emotionally. Do they see him as the hero for staying with me, and me as the burden?'
In fact, the couple – who are getting married in July – have adapted around their new life. 'He eases the way I interact with the world a lot,' Spence Green says. They were at a wedding recently where the dinner was to be on a mezzanine far away from the bathrooms, which were downstairs. There was a stairlift, but it was loud and embarrassing. She didn't want to have to use it every time she needed the loo. 'He was like, 'That's fine, I'll just carry you up the stairs each time.' He holds my dignity to a really high level.'
Among the many extraordinary things about Spence Green, perhaps top of the list is the total lack of anger she seems to feel towards the person who caused her injury. She has always found it helpful to focus on the fact that what happened to her likely saved a man's life. 'I really needed that early on. To think, 'Well, if I wasn't there he probably would have died. Head first – doesn't look good.'' Spoken like a true doctor.
'I thought, 'Well, practically, I've got two options. I'd obviously take the one where someone doesn't die. It doesn't matter really what happens to me, that's just the one I would take.' And if I'd take that hypothetically, then I had to take that in reality.'
Her parents and Nathan have always been on board with her perspective. 'I'm so grateful that they were really led by me. It's much easier to be angry on behalf of someone else, so I'm sure they were angrier. I'm sure they had lots more emotions that they didn't present to me at the time. And I think it took a couple of years to understand this didn't just happen to me, it happened to everyone around me.'
Her parents 'had to deal with so much'. 'They were also much closer to seeing what the media were saying about me or the man. And had to interact much more with the police and figure out all the nitty gritty stuff that I didn't have to.'
He has never occupied her thoughts. 'I don't feel any anger towards him, but I never did. The randomness helped. It also doesn't feel productive in any way. I feel like we met then and our paths both changed, and I've never come across him since.'
In the book, she writes that for a long time she 'felt defined by a sensational headline'. 'An anecdote for strangers to take back home and tell others: my life, summed up in a handful of sentences.' She is 'tired', she adds, of 'answering questions about the man who jumped'. 'It can feel like my life is being reduced to this single moment, forever tied to a stranger.'
It's partly why she wrote To Exist As I Am – to reclaim her story.
Spence Green's flat is filled with art and photographs. A neon sign with the word 'crip' adorns the wall. Everywhere you turn, there is evidence of a life being well lived. It strikes me that the world she and Nathan inhabit here might have been impossible to imagine during those early days in hospital, when everything felt unknown and frightening. But I suspect that in many ways it isn't so very far from the life she was beginning to imagine for herself at 22, on the cusp of becoming a doctor, having met a good man to spend her days with.
Because the truth is, Spence Green's life is like anyone else's. She goes to work, she sees friends, she attaches an extra wheel to her chair and cycles to the ladies' pond on Hampstead Heath for a cold swim. She has dinner with her parents, she curls up on the sofa with her cats and her books. She thinks about the patients she saw today, she ponders where she and Nathan should go on holiday in the summer. Her life is as ordinary now as it was, for a brief, random moment seven years ago, extraordinary. That in itself is a gift.
Read on for an exclusive extract from To Exist As I Am
When the patient becomes the doctor
In 2021, I finally graduated and started work as a junior doctor in a busy central London hospital. It had taken a Herculean effort to get to this point and I was feeling confident, excited. But flashbacks hounded me in the first month. They were unexpected and visceral.
In my first week, as I spoke to a distressed patient who told me he didn't trust the night staff, I was swiftly plunged back to a night in Stanmore [at the Royal National Orthopaedic Hospital] where I had felt so alone, so unsafe. I knew I had a urinary infection that night but had to repeatedly ask the new on-duty doctor for antibiotics. I remember crying in bed for hours until the pharmacist took charge and helped me.
Now, in my role as the doctor, I was constantly asking myself: is that patient's cubicle curtain closed? Does the patient know my name? Do they understand what's happening to them? Are they cold? Are they covered up? I was desperately trying to ensure that the wounding and humiliating things that had happened to me didn't happen to others.
At work I try to remember details from those months when I was an inpatient. Every small act to protect my dignity, every time a nurse or doctor made the conscious effort to introduce themselves properly, to explain what was going on, to make me laugh, to reach out so I felt human in all of it. To cut through the smell of sterility, alcohol wipes and dressings.
My experience with patients has changed since my injury. There is an openness, an eagerness to connect with me that wasn't so present before. My wheelchair acts as a visible scar; I have clearly been on their side of the hospital bed before.
When a patient with a brain injury jokes to me that he sets off all the alarms in airport security, because he has a metal plate in his head, I say, me too, because of the rods in my spine. He smiles.
Me too.
A patient who uses an electric wheelchair tells me that my foot has got caught behind my footplate while I am listening to her chest; she knows all about it, because it happens to her too. She says she can't describe to me how good it is to see a disabled doctor.
I see a patient make seemingly irrational demands and I instinctively recognise the visceral feeling of losing control, the pure frustration. The attempt to grasp at strands of autonomy. How I once raged against the oversized pills I had to take and refused to swallow them.
I am frequently grateful that my injury can put me on more of an equal footing with patients, and for the advantages this brings with it. It helps that I am often literally at eye level to people lying or sitting down. I see other doctors who cannot help but loom over patients in bed. Very tall consultants struggle to shorten their frame by bending, kneeling, and still end up towering over someone. I do not have to worry about this added power dynamic, the physically underlined hierarchy. It can allow for more collaboration, for a real partnership.
But how much power I'm granted now fluctuates dramatically according to the setting I'm in. I can hold a lot of power in the clinic room. I am listened to. But as soon as I take my stethoscope and lanyard off and leave work, I become both hypervisible and utterly ignored. I fluctuate between having a huge amount of responsibility at work, and then leaving and being assumed to have none at all. Writing a person's name down for the last time on their death certificate, then being unable to open the heavy door to leave the office. It is a jarring transition.
It is almost inevitable that I will have a hospital stay at some point in my life for my spinal cord injury, but other doctors in my cohort, in their mid-20s, would rarely expect hospitalisation or procedures in such a definitive way.
But I realise that I can bridge the gap. I can break down the binary between doctor and patient, I can continue to navigate the messiness of multiple identities, to accept these blurred lines.
All the signs that I don't belong in this field make me even more adamant that I do.