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I'm pleased to now introduce our keynote lecture. Mr Mohammed Bilal or Mo Bilal, is a consultant urological surgeon, Queen Elizabeth Hospital Birmingham since 2011 with a specialist interest in your uh urology and urinary tract reconstruction. He is the current chairman of the bow section of female functional urology while cycling with friends who was struck by a tree resulting in a spinal cord injury and paralysis in February 2021 after multiple operations and eight months in hospital with over 1000 hours of rehabilitation. He has returned to his career as a urological surgeon. He will share his insights from his injury and the journey back to work, please. Thank you very much. Which is, is that the uh Thank you very much. Thanks for letting Good morning everyone. Thank you very much for kindly invited me. It's an honor and pleasure to be here talking to the future of urology, which, which is yourselves. Um So I'm hopefully going to share my experience and hopefully we can all get some insights and you know, because we're going to be going through some very difficult times in the next couple of years or even longer So, who am I? So, my, I'm a consultant neurological surgeon in Birmingham. I've been there for over 10 years. My main area is in functional reconstructive urology and what's known as neuro neurology. And so whenever anything affects the brain or the spine actually affects the bladder. Uh And so I've been looking after patient's with spinal cord injuries or patient's with congenital problems that spina bifida for a number of years and during the COVID period, as we all know, uh it was a very challenging time and the only time you could actually go out was when you could perform exercise. So during that period of time, we were doing Birmingham's very, very affected by COVID and we were doing four days on four days off, we have to cover COVID boards, COVID intensive care. And so you always needed to release. So I took up cycling, recreation, cycling in May of that of 2020 became what's known as a mammal, middle aged man in LYCRA, a very tedious person who talks about gearing ratios about the grease, how that makes a difference. I'm not going to bore you with the level of detail. I got to uh became a very tedious person and the wife and kids stopped talking to me. So it's probably February half term 2021. Um And when you become a tedious a cycling, every opportunity you have uh you take and so on that fateful morning, my NHS clinical was canceled. And so the first thing I wanted to do was to go out cycling. So I rang up, a friend of mine and the listeners got cycling. It was a cold day, there was no wind and off. We went and at that point, this photo was taken 30 seconds before, before the accident. We've probably already done 40 kilometers of cycling about hour and a half in. And it's likely you've taken in turns, you know, you, you do because of the air resistance, whoever's in front uh takes more has to work harder than the person behind. So, you know, every few miles you take it in turns to reduce, you, reduce the burden and living in Birmingham, you try and avoid cycling in Birmingham. It's like a death trap driving in cities as you all know. So we decided to go out in the countryside. Uh And it was a really bizarre day because, you know, we were working quite hard and it was, it was a beautiful countryside and suddenly out of nowhere. I recall the tree falling and it was fully so quickly. And I remember thinking, damn, that's going to hurt. And so the next thing I do is I remember waking up and I tried to get up and the incident realized I was paralyzed from, from, from the belly button down. And the weirdest thing happened, I visualized myself in a wheelchair. And then the second thought was, it was going to be a long journey. And the next thing that happened and it's a bit similar to when you stub your toe, that you have a half a second delay before the pain kicks in. And I have to say the pain was rather significant. Uh the worst pain you can imagine. So, so that's, that's the actual tree and that's my actual bike. Uh And in the distance you can see the ambulance coming. I was very fortunate it wasn't an ambulance strike that day. So I was very pleased with that. So, so eventually the ambulance guy arrived and I remember it was a weird sensation and he came up to me and he said, look, I've got you some paracetamol. Uh I, I was in so much pain, I don't think that's gonna work. It's no, no, I promise you it's gonna help. And at that point, I realized I broke my back because I was paralyzed, but I'd already also broke my ribs, my scapular had a human hemothorax. And so I knew it was an enormous amount of pain. Uh but it's interesting what you remember uh those times. So I was then transferred to the local trauma center, which happened to be commentary and not my local hospital. Uh and they are sustained multiple fractures. And as you can see from the MRI scan of a significant spinal cord injury and the weird thing was there was no panic. And I think maybe it's, the training is a surgeon in times of stress. We, we were very calm and there's a degree of serenity. There was no panic. I knew I had to get on with, with emergency surgery. I was very calm all the way through and said, let us crack on, get on with the surgery. Um, and so that night I was operated, operated on, uh for you, cycling aficionados, you, I'm sure you're wondering what happened to the bicycle. The bicycle frame is still intact. I have his memento. Um and I was very fortunate the wheel wheel actually collapsed. So that prevented me from being trapped under the tree. So what actually happened was the tree hit me at the exact moment I went by which is in credible. So, um you know, it had to be and so in a way it made easier, you know, that, that this one in a million accident where there's no wind and the tree to hit you when you're going 40 kilometers an hour, that tree was meant meant to be. And as we all know, I think if it's not on Strava, it's not happened. So this is my final cycle ride. Uh I'm pleased with the average power. That's how tedious I was at a parameter and the average speed. So at least at least I left on the high. So, so as you say, it's really important to put your ride on Strava. Okay. So, so what happened next. So I think is this weird realization known that you are paralyzed and, and, and going through all the different sort of pain, which is the main memory I have. So sort given insight in terms of what it was like. So you lying in the bed and I have you on zero degree. So straight after the operation, I recall, uh you know, having the PCA the first night and every time I woke up in the middle of the night, kept in passing the PCA thinking yes, only a dream. And so, but coming to come in the morning, I realized, you know, a good night, the PCA but then he was in a dream. So zero degree is actually quite difficult, especially with broken ribs and they turn you over four hours of one side, four hours, the other side, four hours on the broken ribs, four hours off the broken ribs. And the feeling you have is a feeling of suffocation. And the weirdest thing is, it's about the loss of your autonomic system which you don't really think about. I just couldn't control my body temperature. It felt like I was an inferno. So you have the fans on and you just feel that, you know, that you just can't control control it. And the biggest thing I remember was pain, you know, and I think the pain of the trauma of the accident with the multiple injuries and also the pain from the surgery. And the weird thing was I thought, well, spinal injury, you're not gonna feel anything, but actually, your perception of pain is in your brain. And so the pain was worse than I anticipated. So this is the, the surgery I had initially, which was a series of metal bars inserted to try and stabilize. And I remember, uh, a very big scar, uh, on my back, which I always like to show off. And uh and the weird thing is that you do reach a crescendo pain. And, and, and so I certainly remember it must have been in day five, day seven because the day sort of blur that the pain increases, increases. And the PC and the pain killers don't really make a difference, which is we have been been the surgeon on the side. I mean, how often do we deal with patients in acute pain? And ultimately, it led to a ketamine infusion and what we'll say I care to me, this is one hell of a drug. These are the most psychedelic hallucinations. Uh So when the doctor asked me any side effects, I, I didn't know and I knew I knew he was going to stop it. And what it does is it dissociates the pain and it allows you to reset the pain. And so allowed to break that cycle. And the cycle was related to this constant coffin with the broken ribs, broken scapula, it was sort of get into crescendo. Uh But the thing with all pain is the pain will eventually settle and the pain will improve. And you always reaches or pinnacle where the pain is. And then, then there's a downward downward slope. I was extremely fortunate to be able to go to a spinal unit. There's 10 or 11 spinal units throughout the country. And it's very fortunate we have to go to the London spinal unit, which is one of the best. Um, this is me and it was rather cachectic state. I have to say, uh I was weighing as, as well, probably 65 kg, which I hadn't been since I was 12 years old. So it's amazing how much wage you losing that, that cata bolic state. So if there's one thing I want, want you to take out of this talk, is that what you see when you see a spinal cord injury patient is only the tip of the iceberg. You see someone who can't walk, but actually that's the least of the problems. And so beneath that, you know, the biggest problem's the spinal cord injured patient's have is the bladder bow. And that's something, you know, when you give them a chance, a number of years down the line, they'll, they'll say to you that actually are rather how my bladder bowel sorted out than be able to walk because that has a much bigger impact on the quality of life. There's obviously the psychological battle there's a constant sort of neuropathic pain which I'll uh come, come up to and this is constant need to avoid pressure source. Um So when you see that, we all see this one according to your patient's in wheelchairs, just remember that's just the tip of the iceberg. So what happened next? So we went to, to the Linda spinal unit working hard with the rehab to three hours a day. And the purpose of the spinal cord injury unit is to help you make you safe and be able to live, stop to go home with some basic skills. So what is rehab? So, so the best analogy we have is that you've constantly got to push yourself outside your comfort zone. If you want to progress, you, you constantly need to keep on pushing and pushing. And a simple analogy would be if I was to ask you to jump a meter, we'd all jump a meter without a problem, obviously not me. Uh But if you asked you to jump a meter between two buildings, you have a degree of interpretation. Uh And if I was to say to someone to jump between two wings of a plane, a meter apart, that's a different level of fear. And that's the sort of fear that you have that if you were to fall, fall off, the wheelchair is very, very different than how normal port would fall. And so you constantly have to, to be able to push past that. And that's where one previous occupation, my current occupation, surgeon was very helpful. Of course, in my time, it was a very difficult time during COVID. It was no visitors were allowed and eventually my wife was allowed to see me once a week, which was chaperoned to me to distance. Um, and you were not able to leave, leave, leave the unit and so on my birthday, I worked very hard for six weeks. Kept a very positive attitude, hadn't seen the Children and uh the game of the good news that we're going to send you home in a couple of weeks time, but before we send you home, we'll just do a repeat scan just to make sure everything's okay. So, so the next thing was the density scan to look at it. And as soon as I saw the scan, I realized then that the, that the journey hadn't ended, the journey was there's going to be an additional chapter or could fail a degree of discomfort in my back clicking as I regarded. But again, I kept on pushing forward thinking. Well, you know, that's to be expected and had the space severe neuropathic pain down my leg, which the only way I would describe would be someone having a red heart soared, chopping your leg off. Uh And so the, the sort of neuropathic pain is on a different level of pain that you experience. Uh So what do you do a week before discharge and mentally prepare myself to go to, to go home. Um, and then having climbed that first mountain reach a point where you realize now you've got a big a mountain to climb. And I think it brought back memories about the pain from the first operation. I realized any redo spinal surgery is fraught with difficulty. Um, but you need to reframe it. So reframed as I was very fortunate that I was able to go home, have my surgery done before I go home. Uh so that I can carry on with my life. So it's quite an epic operation. 12 plus hours. I was very fortunate to have three amazing surgeons, a vascular surgeon. As you can see, the aorta is very close uh spinal surgeon, neurosurgeon. So they went through the back that took out all the metal work, went through the front, put multiple cages inside, took out my rib that hurt. Uh And then we redid it. And so it was is then going back from all the progress I made back to square one, back to bed, rest, back to line flat, back to being turned every four hours um which is rather than pleasant. And so it was five days in HD you and then, and then another 34 weeks in the hospital. Um Not surprising me. The one thing I will say is if your healthcare professional and you have to have operations, you will definitely get a complication. It's just one of those rules really. And so I managed to get so as abscess uh almost an a flawed reaction to, to tie complaining. But finally, after 2020 20 weeks, I was able to, to make it back, back from, from the hospital to home. And now that was a, a very important time. So this is me in, in the wheelchair. Now I've got a brace. And so what they do is they, they create a cast and then they create this very hard polyp uh carbon frame around your chest, which is rather compressive. Now, I made a mistake that, that year I thought black was a cool color uh before she was a very hot summer. Uh And so I should have had a, so I still think it's a cool color, but I think I did sweat a lot. I must admit it was very uncomfortable. Uh You could barely go after two minutes out in the sun before thinking you were about to die. So, as a surgeon, as always, you formulate a plan. So in my mind, I formulated this plan that, that there's three components to my journey, a physical part, uh mental part, in the spiritual part. Physically, I knew that was something that I could do I could when I get home, instigate my own rehab plan, instigate a formulation of how I was going to get as good as I could. A mental plan continue to maintain positivity all throughout that time, I've been waiting for the collapse of positivity and it's not happened thankfully. Um And I have to say there's been no negativity which has been the most amazing thing. Um And the spiritual aspect that you've got to make sense of what does this mean? Uh My, my faith helped very significantly through that unfortunate coming home, had different challenges. Sadly, the community services we all know as a surgeon is rather limited, I had very limited support uh from, from the community certainly uh lived so formulated a plan. I was a lot of pain killers or neuroleptics, uh gabapentin uh amitriptyline. And I realized that I couldn't get back to surgery being on such a high amount of pain killers. And so I did what my patient's always tell me that doctor, I don't want to take any tablets and so formulated plan to wean myself off over 33 to 6 months. And it took a very long time to wean off. And so it's about reframe the pain, accepting that you do have pain. And that's fine only when the pain becomes sufficiently difficult, then you can take some painkillers. But actually just trying to desensitize your system that you accept that there is pain. But it's only when the pain is significant that you take it. The next week, challenge was being able to learn to drive again with a hand controlled car, uh that took about a year predominant because the D V L A kept my license forever. You couldn't concert the D D V L A. There's no telephone. I wrote multiple letters and eventually, until I wrote to my MP that finally gave my license back and I was very lucky to be able to get hand controlled car. So I formulated a plan each day. I do three hours a day and I still do three hours a day, five days a week. Uh and also finding the right healthcare professional to help me. So every day I do a muscle stimulation. So I have a series of pads on which I go through all the different muscle groups in my lower limb. Uh electrocute myself and ask to maintain my muscle density as to, to, to maintain, reduce the chance of pressure source. Uh I also have a standing frame which I stand every five days a week, 30 minutes. Uh We can ask to maintain my bone density and to prevent uh leaching of my calcium. And as a urologist, the last thing I want is to have kidney stones. So that, that's the reason why uh he's at least a couple of times a week. Um And I was very fortunate then I was able to have the financial means to go through two sets of inpatient rehab where we spent four hours a day with him. And I've spent an additional two hours a day with the muscle stimulation or six hours a day, I'd spend, uh five days a week, uh for essentially three months. And so it's never given up and realizing in your rehab doing it 10 times is not enough, doing 100 times, it's not enough. You go to 1000 times, uh to get the gains and it's just not giving up. And if that's the key thing is, is really never, never to give up. It was also fun. I managed to achieve to lifetime goals, uh want to have a beard like Father Christmas. And the second was to be like an Asian bodybuilder with big arms, big chest and skinny legs. And so, you know, I'm quite pleased I managed to achieve those two girls. So it took a year, a year of a lot of patience and, and surgeons were very impatient. And one of the things I've really learned is patience. We, we have to all be very patient and as trainings, you have to be patient, you will definitely get. There is just a matter of time. So it took a year for, for my spine to heal. And it took a long time. I spent another eight months with the brace, which made it very difficult in terms of basic stuff. At the end of that year, I was not able to even sit by myself. And so uh I had to jump on this very intensive uh therapy, I'd really get myself planned I was going to go back to work in a year's time. Uh I think that was rather unrealistic plan. Uh When it came out a year, I was not in any physical shape and then I delayed the plan by six months. Uh And I was very lucky as I gave a time frame that I was going to go back to work in September. Uh But due to the usual delays, I managed to make it back in November, which was just about quite time. I had the misfortune of dealing with uh the Department of Works and pensions because they want access to work scheme. I have to say that was, that was a big challenge in itself. And it made me realize that we're in a very privileged position. We forget when people fall on a misfortune. Sadly, they have to deal with government agencies which are rather challenging. It was very, very fortunate. I had amazing man sport for my, my friends, my family and also for my colleagues and for my trust. And they allowed me the opportunity to have ownership on my return and what I wanted. And I was very lucky with the inpatient rehab. I was able to explore the different equipments would allow me to pretend to surgery. I formulated a simulation day. I've got my private physios and my colleague Tom who's who originally trained as well as the theater nurses. And we went, we went through all the different equipment, made sure I was very comfortable how I was gonna scrub up, how they were going to help me get scrubbed up. What positions I'll be for my surgery. And, and that, that was, was, was a very helpful day. It made me realize that there shouldn't be any problems in terms of moving forward, ready, back in the beginning of November. And an amazing time with everyone was so happy to see me. And, and that's a picture of the first day after finishing a couple of artificial sphincters, which is my main area specialty, amazing love and support from everyone. So how about what, what are the take home message is really, I think from a professional level, the key take home message is really bad communication. And I think all of us here, you know, we, we, we, we have to remember whatever you say, you remember as the patient, I remember everything that was said to me, uh all the kindness that was shown to me or the great. And so I think it's really important as clinicians that, that the communication is key, showing some kindness and showing some compassion, makes all the difference. And it made me realize that we have to also take what the patient's are saying uh And what the patient's got feelings are. And certainly I found that that when I had a sinus tachycardia and I remember after the second operation, saying to the healthcare professionals, look something's not. Right. No, no, no, you're anxious and I'm not the anxious type. Uh And, and indeed, once they, the scan with the realize I had a collection and so quite often when our patient's tell us, look, something's not right. We do need to take that seriously. Uh And sometimes you don't, but I think it's really, really important. The second thing is about pain we do with patient's suffering in pain, but actually been on the other side is much more worse, worse than you can imagine. And that neuropathic pain, like I said is probably the worst sort of pain. Um And it's on a practical level, I'd say try not to remove ribs. Yeah. Hurts like hell. And so urology, you know, if there's a big uh kidney cancer in the past, we've removed ribs and it does hurt like hell. And the other thing I realized the self catheterization is not difficult, but it's not that uncomfortable, but it's still a gel is and how many patients I've given in? Still a gel. And we always say to the patient look, it's going to sting. Oh my God. Does it sting or one? So do you want to see you better off just giving them Ky jelly? How about personal messages? The thing I'd say is gratitude. Honestly, we have so much and we forget what such a privileged position we're in and really understanding that what we do have is so important. Always looking at the person below us, not the person above us. I'm forever grateful. I've managed to get back to work. I'm over the moon, I've still got the use of my hands, my brain, an amazing amount of love and support for my family and friends and what's it not to be grateful for? Um I think in terms of framing your journey, you need to frame a journey in terms of series of hurdles and not necessarily look at the final destination. And so when I look at the whole journey and tried to became too overwhelming, so I broke into series of steps and a series of mini, mini hurdles or, or mini ultra marathons. And that made it so much easier. And what are the feelings you have will come and go and it will pass. And I was very fortunate that generally have a whole, I didn't have much negativity to be days or mornings. You feel a bit upset and it's fine to embrace that feeling of unhappiness and say, look, tomorrow is a new day and it always is a new day and always looking at things in a positive way and realizing that actually at the end of the day, what's there not to be grateful for? So pain, the way I kind of dealt with pain was to release a look, going through pain, you need a positive. And the way I looked at pain was when I was going through pain. It was a purification of my soul. And so it meant there was always a positive and I think we managed pain all the time. We see a lot of suffering sometimes we become desensitized to that. Um And so I always remember the patient's in, in, in pain to give him adequate pain relief. Uh And in terms of, I think it's really important, the surgeons that we have to learn and accept uncertainty and that's you have to embrace that. There's so many things we can't control. And I think once you let go of that, that that will help in many ways and no one knows what the future holds. And so, so I think we're going to go through a difficult time and we're going to go through pain. But actually at the end of this, I guarantee, guarantee things will, will be better. And if you have friends going through adversity, simple kinds of act, kindness are so important. The simple text message to say I'm thinking about you makes a world of difference. And, and so that would be really important. And with adversity, it's actually a gift. It's not overcoming adversity. It's a gift of adversity. It's give me a second chance. It's like to re prioritize important people in my life. And as surgeons, we spend a lot of time working and sometimes we neglect our families. And my message to you all is never forget your families and make sure you have enough time to spend, spend with them. And the final bit about hope and hope is not denial. And that's why I realized patient's always need hope and sometimes we can crush that hope. And I think it's really important not to, not to do that. And I've given a simple experiment that did a number of years ago. And it's rather cruel experiment whereby they took rats in the parliament water and let them swim. And after 15 minutes they think, and then they die, the repeated the experiment, 13 minutes took the rats out, given a couple of minutes, rest, put them back in and they carried on swimming for hours because the rats thought they're going to be saved. And so what hope can do is allow you to push. You know, I always had hope and that's why I did over 1000 hours and probably up to 1500 hours, I've always had a hope that things will get better. And so it's really important and, and hope it's so important that we make sure whatever our patient's going through that we don't quest there, hope and that there should always be a hope in, in, in, in, in, in our interactions with, with our patient's. And we always remember those patient's who, who you thought. Well, I don't think they're gonna do so well, but they kept very positive and we actually exceeded the expectation. And I think that's what hope. Hope can do. The final take home message is what I've realized my time is that all of you guys do an amazing job. Remember all the junior doctors who helped me? And no one tells you how much of a fantastic job you guys do. And that's why I'm telling you now. Uh and they were do an amazing job and being on the other side to realize how much of amazing job you do. And it's extremely gratifying to receive uh letters for my patient's uh made me realize all the positive impact I had throughout my journey. And I think the key thing is is we're gonna be goethe an extremely difficult time, but we can't give up and we're gonna keep smiling and pushing forward and I guarantee you that will be brighter days and there's always hope that things will improve and a big thanks to it to all my family, friends at my hospital. Thank you very much. Yes, thanks so much. Thanks very much. Yes, you're joking. Absolutely. Thank. Thank you so much, Mr Bilal. Thank you so much. That was a unbelievable talk. And thank you for sharing such specifics in the details and with such good humor as well. I mean, we have to be grateful for that and we mentioned our conference theme of reconnecting and inspiring. And if that's not the key message of what you've explained to today, I don't know what is so. Thank you for that. Thank you for your also offering to take some questions. Now, I can't see if the Emily is still running around the mic there or Angela ah Michael, see if anyone in the audience has any questions for us. But in the interim period, first thing I want to start off by asking is that you, you speak so much of all of the hope and positivity going forward following significant difficulty. So we've heard this morning from the Royal College President's of the challenges faced by the junior doctors, the young individuals, all of us in front of you today. What message do you have for us to keep going and keep positive? Yeah, definitely. I think, you know, when I was in a position whereby I was not allowed to do the job I loved, I realized how much I love my job. I've always loved my job and you all love your job. I think things we get upset about is the system, infrastructure, the things outside the most crucial part, which is the doctor patient relationship. And you know, this is what we really love. And I think a lot of us have fallen out of it, out of that love simply by the system. And the thing I would say is the system will change and the system will get better. And there's a cycle of life and there's a cycle which goes through 20 to 30 years. And the thing is, it's moments like these that we have to show our true courage and are true persistence. And I guarantee you that things will get better and we just got to be patient. It's going to take a number of years where we can get through this and you guys are the future. And so it would be, you know, unfortunately, if you were to give up at this point, but like I say, your, you know, your true character when you go through difficulty. And so we should, we need to reframe this as, as a showing how tough we are and how we can overcome these challenges. And, and the thing I've learned is we can overcome these challenges. It's just a matter of time and we've all got to learn a better patient's and, and that is tends to be the surgeons Achilles Hill, but we, we need to be patient and realize, I guarantee you in 3 to 5 years, things will get better. Yeah, you can find me five years time. A guarantee, things will be better. Phenomenal. Thank you. Anyone from the audience, Michael. Go for it. Um Hi, I'm Nafisa. I'm a third year medical student at King's. Um Firstly, I wanted to say thank you so much for this talk. It was really brilliant uh um inspiring. Um I had two questions actually. Um The first one was um let's say you had this accident like much earlier on in your life before you start your uh your career. Uh, do you think you would have still chosen the same path? Um, and secondly, um, if you had to give advice to someone who's dealing with a chronic condition and chronic pain, much, um, who's much younger and about to start a career in surgery. What would you say to them? Yeah, I think it's the different stages provide different challenges. And I think it's our focus that, that, that if you, it doesn't matter where you are in your journey, that adaptations can be made. And so I'd say that the surgical specials are far more inclusive than they used to be. And so we live in an environment where we understand there's a lot more of inclusive environment. So even though it's a medical student of this, there's people I know who are able to overcome and make a accommodations. Uh so they can continue that onwards. I think in a way to look at chronic pain and chronic illness as a doctor is actually makes you a far better doctor, makes you far more understanding doctor. And actually it would be a massive loss to lose a condition who really understands what's going on. And so I think you can use that illness or use that chronic disease or chronic illness as a positive and say, well, actually use a different perspective, a greater degree of empathy and understanding of what the patient's going through. And certainly the accents, maybe a far better doctor And so, so if you frame it in that fashion, then you have to continue, not just for yourself but for the patient's fantastic. Well, look, I think that's our time for the first session. Thank you so much and uh we'll take a quick break before returning to our second plenary session, building surgery for tomorrow, which will be chaired by my colleagues, Mr Michael Elboghdady and Mr Lona Courtney. Thank you all very much. Thanks very much. He's always alright. Unbelievable, unbelievable.