Note: this essay contains discussion of orthopaedic injury that some may find distressing.
I lay screaming on the floor of a conference centre in Gwangju, Korea, with dozens of concerned onlookers around me
Twenty-one hours later I gave a talk on 'digital transformation in energy' in front of 300 senior energy professionals.
In November 2019 I was invited to speak at a high profile conference hosted by the Korea Electric Power Corporation. (You can also read my ultimate guide to public speaking, which is based on my experience around this event.)
I arrived late on the Tuesday and then on Wednesday — on my way to lunch, no less — my left knee decided to dislocate itself. I hit the ground hard, smashed my phone, and found myself screaming in pain.
I say "found myself screaming", because my awareness of the process was like a dream that ended when I hit the ground. Within seconds I had already grabbed my knee with both hands, forcibly straightened my leg and pushed inwards on my dislocated kneecap until the pain, and the panic, blessedly eased as my kneecap snapped back into place. Within five minutes I was limping away as the shock slowly subsided.
I looked back to where it happened and there was nothing that could have caused it. I can only assume that my shoe slipped ever so slightly on the polished floor and in just the wrong way. That’s it. No way to predict or avoid it.
As you might tell from my somewhat dispassionate tone and obvious experience in relocating my own kneecaps, this was not the first time. It’s a thing.
It happens rarely enough that my life is largely unaffected — I can do most of the things you can do — but often enough that it’s always on my mind as something that could happen. And when it does, it’s always a surprise, because it never happens when I’m being careful, which means I’m almost always being careful.
As such, the whole recurrent knee dislocation thing has become part of the structure of my psychology and identity. I’ve noticed two key psychological effects that are worth highlighting.
The first is hyper-vigilance, a way of being that is stuck in ‘scanning for possible dangers’ mode. Hyper-vigilance makes me notice the people playing football way across the park, the uneven road surface a few feet away and the kid jumping off a low wall.
The second is intrusive thoughts, where some content from the world creates sensory flashes in my imagination. Intrusive thoughts show me what would happen if one of those kids kicked the ball directly at my knees, if I were to step awkwardly on that uneven surface, or if I were to jump off that wall.
And it’s incessant. On a single bad day this might happen hundreds of times.
“What would it be like if that happened right now? How about now? And now? Oh, and now?” — the intrusive thoughts in my head.
While I’m grateful that my brain doesn’t recreate the feeling of pain itself (I suspect family sizes would be a lot smaller if brains did this), it can accurately recreate the feelings of ‘wrong’ associated with knee dislocation, so these intrusive sensory flashes are unnervingly realistic. They also seem to bypass the rational centres of my brain, so I respond physically, often flinching or reaching for support before ‘I’ am able to intervene.
As I’m sure you can imagine, this is a recipe for both chronic and acute anxiety, and I’ve had to develop various strategies to manage these on an ongoing basis. Ninety percent of the time you wouldn’t notice what’s going on in my head, but sometimes it gets too much to hide.
I’ve gone into some detail about how unpleasant all this is as a set up for the big reveal: a large part of me is grateful that I’ve had this experience. It has helped forge my identity. I’ve now reached the point where I’m not even sure if I’d trade places with ‘me with working knees’.
I’ve been falling down like this pretty regularly since I was 11 years old. When I was younger my kneecaps didn’t fully dislocate. They would wobble, I would fall over and scream in pain, but the kneecaps ultimately stayed in place. After a few minutes the pain and weakness would subside enough for me to get up and limp away.
I was bullied incessantly for this at school. It looked like I would just randomly fall down, make a bit if a scene, and then walk away. I sucked at sports, but it wasn’t clear why, so I just looked uncoordinated and lazy. More than once other kids actively kicked my knees in for laughs.
Doctors largely couldn’t help. My kneecaps were hyper-mobile, but there was little that could be done even with the surgeries I had, which meant I was on my own to live with it. There was a stage in my teenage years when my knees would give out like this every few weeks. Each time I would fall, it would hurt, I would feel angry and frustrated, and then I would have to get up and get on with my life.
At that’s the key: I got up, every single time.
At first it was difficult, but over time it became habitual. I would go through the same physical and emotional rollercoaster, but cultivated a kind of acceptance towards it. This is the one area of my life where I have never told myself I shouldn’t feel angry, or sad, or in pain.
Over time a kind of programme was coded into me: fall down; get up. Fall down; get up.
While I’m always in physical shock immediately after it happens, I notice myself quickly reassuring the concerned witnesses who moments earlier saw me yell, swear and writhe as if possessed by a demonic spirit. No, I don’t need an ambulance. Yes, I’ll be okay. Thank you for helping me. I even crack jokes, while still visibly shaking.
This programming extended to the rest of my life. I’ve fallen many times and in many domains and this response has always kicked in. I've never allowed the ‘fall down’ state to become the new default state. It’s part of my identity now: I am someone who falls down and then gets up.
I want to make clear that I’m grateful that I have always been able to get back up. I know there are many people who don’t have this luxury. None of this should be read as me having a tough love approach to navigating personal adversity. I’m aware that I have always had the necessary support and safety nets to help me recover. That doesn’t stop me valuing the agency I have developed, but it does put it into context.
In the days immediately after I dislocated my knee in Korea I travelled to Seoul for a pre-planned long weekend. My knee was hugely swollen, but I wasn’t going to let that stop me from looking around (I make no comment about how sensible that was or wasn’t).
Over that weekend I wrote this:
As I once again go through this now familiar physical and emotional rollercoaster, I once again find solace in the fact that I have taken something positive from it.
I'm limping around Seoul, but I feel strangely anti-fragile, each painful step reinforcing my sense of self and resolve to keep exploring.
Seems ironic to call it ‘anti-fragile identity’ given how fragile I feel at times, but that’s part of the fun.
And at this point, I don’t think I’d trade it for anything.