How lunch with a friend caused years of trauma
Bethany and Rob had been secretly dating for weeks. They planned to meet a friend for lunch to reveal the happy news but on the way there an accident changed Bethany's life.
It had been raining all morning and the halls in the science lab at the University of Bristol were wet and slippery.
Bethany Hickton had been in the building for hours working on her PhD - a mixture of biology and physics in the form of aerospace engineering with cellular and molecular medicine
As planned, she met her new boyfriend Rob and they started towards the university canteen for their lunch date via a staircase. They were looking forward to breaking the news of their burgeoning romance to a good friend. It was then that it happened.
"I slipped and fell," Bethany says. "I missed a few steps and landed on the bottom of a flight of marble steps on my coccyx.
"As soon as I hit the floor I knew something was wrong."
Pain shot up her spine, people rushed towards her and someone called an ambulance. Rob "came hurtling down the stairs looking as white as the staircase", bringing any secrecy around their relationship to an abrupt end.
Fearing she may have sustained a serious back injury, Bethany knew to lie still. She remained on the floor, able to see Bristol Royal Infirmary through a rain-splattered window, and awaited the paramedics.
They put her in a spinal brace and took her to hospital where she was assessed. Bethany recalls that she "wasn't kicking off" so the staff must have thought she had a light injury. She was taken in a wheelchair for a precautionary X-ray and was asked to wriggle out of her jeans.
"The doctor was pretty alarmed when she got my X-ray back," says Bethany.
It revealed very significant damage - the fall had compressed her spine and broken three vertebrae.
"The fractures were five millimetres from severing my spinal cord," she says. "It was pretty scary."
Fortunately, although she had moved her body, there had been no deterioration of the injury.
Bethany's initial care was swift and ordered. Within days she was discharged with strong medication and a spinal brace, a metal and plastic contraption that she says quickly became the bane of her life as she had to wear it whenever she wasn't lying down.
For the first 10 days she slept 22 hours out of every 24, only waking to use the bathroom and eat. Then, being a scientist, she started to match the rigorously planned care from the NHS with her own logic as she took control of the situation.
"I was all about strategic plans - how we were going to modify my flat so that I could get around. They said I wasn't allowed to shower for 16 weeks, which just wasn't happening - I'd only just got in a relationship. So, we figured out ways that I could shower without moving."
The "hodge podge" method involved Bethany sitting on a perfectly placed stool and carefully removing the brace without moving. She would then retrieve shower gel from a caddy placed on the floor and let the water wash over her.
After months of solving those immediate problems and being emotionally strong, Bethany came off the medication. Pain returned and she could no longer sleep.
"That's when it all sort of caught up with me," she says. "Sixteen weeks is a long time to not cry about something."
The next stage of her recovery would become the greatest challenge. She found she wasn't able to go anywhere and, although academically inclined, could not read books. All her focus had gone.
"Everything stopped, and that was really what shocked me," she says.
Added to this, thoughts of what could have happened, plus a fall behind in her PhD, all contributed to a decline in her mental health.
Bethany discovered later that these feelings and symptoms were typical for people experiencing post traumatic stress disorder (PTSD).
Professor Neil Greenberg, of the Royal College of Psychiatrists, a specialist in PTSD, says a delayed emotional reaction of between one and six months is very common following a traumatic experience.
"People often go into a phase of what they have to do to get better and it's not until you reflect on how near a miss it was that it may start to lead to mental health problems."
Symptoms of PTSD can include re-living the event, intrusive thoughts, difficulties with concentration and negative mood.
Professor Greenberg says: "Most of us won't think twice about going down the stairs but Bethany might become cautious or think other people are being unreasonable by going fast. It changes your view of the world."
It can, he says, also alter the way you experience pleasure and satisfaction.
Bethany found it increasingly hard to motivate herself and began to experience panic attacks.
She remembers the first attack: "I was sat in my bed, not really being able to breathe, and I just sort of suddenly felt very cold and very numb. I went and stood in the shower and just blasted myself with water until I felt better again.
"I think the cause was actual fear of how close it came to being a lot worse. I could have been paralysed from the waist down."
She expected and hoped things would improve when she got back into her routine, but that too became a trigger-point.
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"I started having anxiety attacks about going to work. I found myself walking a different way to work. The shoes I wore the day I fell, I didn't wear again."
She made it through to Christmas and toasted the New Year. It was 2017 - a fresh start.
But on the night of 1 January, she couldn't sleep.
"I kept having intrusive thoughts and my mood was just horrific. It just dawned on me that, actually, I'm not the person I normally am and I haven't been for a while.
"That was when it really hit me that maybe I should go and talk to someone about it."
Bethany went to see a counsellor and spoke of the ways she had adapted her life to avoid anxiety. She was prescribed anti-depressants and offered a talking therapy to deal with the trauma.
She agreed to try CBT or cognitive behavioural therapy which focuses on the "logical versus the negative". In this case, she had used staircases thousands of times without incident, but only fallen once - she needed to re-route her brain onto that reality.
When it comes to PTSD "you need to avoid avoidance", Professor Greenberg says. "People don't want to think about the event, so they tend to avoid it, but what really helps is to bring the image into your mind and confront it."
Typically 70%-80% of CBT patients recover and Bethany says she found it improved her anxiety.
She also turned to exercise through the University of Bristol's Healthy Minds programme, which encourages students with mental health difficulties to improve the way they feel through sport.
It was there that Bethany, unexpectedly, found a love of weightlifting.
She kept her medical team informed about what she was doing and found it "joyous" to find her back was strong enough.
"That was a breakthrough point for me", she says, for both her mental health and physical health. "When you've had an injury you become so precious about it, that actually pushing it was really nice."
Bethany thinks it could be another three years before her back recovers fully - the bones have healed but it will take longer for the muscles and tissue.
"It's still something that's sore and painful, but it's manageable and hopefully improving."
She has returned to her PhD with hopes of becoming a chief scientific officer - someone who looks at complex scientific issues for the government - and her romance with Rob has become long-term.
While she feels her mental health has improved, she still has to confront her fears everyday.
"Whenever I do go down the stairs in that building I have to hold onto the handrail - and if I'm wearing high-heels I will pick ways of walking that don't involve stairs.
"I try not to let it become a thing. I obviously still happily go to work but I do still have a little issue with those stairs ... me and them are not friends."