Paul Hayden sat on a chair surrounded by a pool of his own blood while his son, Ricky, lay dying in a hospital bed next to him. The pair had been stabbed several times as they tried to stop a moped being stolen from outside their east London home in the early hours of the day before.
Ricky, 27, suffered a deep wound to his left thigh that severed a major blood vessel, causing catastrophic bleeding, while Paul, 54, was knifed in the arm, hand, leg and foot – the bottom of which was left “hanging off” because it had been “hacked” at so ferociously. At one point, he was told to expect amputation.
That night, just over 19 months ago, marked the tragic cutting short of one life and the abrupt dawn of a decline for another. The cruel double blow of enduring the loss of his adored son and surviving such a vicious attack means Paul is unlikely to be the same man who woke up on that ill-fated morning again.
“I wish it was me, not him,” Paul says, visibly distraught as we sit in his living room watching footage of Ricky’s funeral on the television, surrounded by the last vestiges of his son – the urn holding his ashes, old family photos and a glass cabinet displaying treasured keepsakes. “He wanted to do so many things. He worked so hard, never caused us any problems.”
The scars Paul bears and his withering mobility are constant reminders of the atrocious confrontation. So too is the conspicuous scar that runs across the chest of the family’s dog, Roxy, who was also slashed.
After spending every night curled up in bed next to her “best mate” Ricky, the staffy now cries for hours on end at his palpable absence. “We were told a few months ago to have her put down because she’s so stressed,” Paul says, while Roxy lies whining at his feet. “They gave us a spray to use to calm her down but she howls. She’s had a really sad face since…”
The nerve damage and metal plates Paul now has in his right hand mean his dexterity is limited. Even small daily tasks are challenging. “Have you ever tried to hold a toothbrush when you can only get grip from two fingers?” he asks, as he demonstrates that he has to force his fingers to clasp using his other hand. “It cuts your mouth to pieces. Sometimes I can’t even lift the kettle.”
Paul walks with a stick on the occasions he does manage to leave the house and is forced to sit for frequent rest breaks. He has a wheelchair too – but hates using it because, “it feels like they’ve got me”.
Watch: London’s Knife Crime Emergency: ON A KNIFE EDGE
He drinks morphine “out the bottle”, and takes painkillers, antidepressants and sleeping pills. But the tablets, he says, don’t touch it. At night he lays on the sofa – getting up and down the stairs is too hard – and watches reruns of The Big Bang Theory to stop the thoughts plaguing his mind. He sleeps only for two to three hours, with even these short spells of rest fragmented by panic attacks, vivid nightmares and upsetting flashbacks.
Someone who’s met dozens of people like Paul is Jo Manson, an ST8 general and vascular surgeon who’s worked in London’s major trauma centres for the past 10 years. She sees the fallout of the nation’s growing knife crime problem, which surged to a record of almost 40,000 offences last year.
Getting patients out of hospital, she explains, “is often the first step in a long journey.” She continues: “The dynamics of how that [stabbing] plays out is part of the emotional burden that goes with the injury. No matter what happens there will always be a scar, a memory, a lifelong association. Even superficial skin wounds that can be fixed with stitches and a couple of weeks of healing will probably lead to a lifetime of memories about the event.”
The major trauma centres in the capital specialise in treating severe stabbing injuries, those most “associated with a risk of dying”. “Many require a surgical operation to fix them and what you do to fix it depends on the injury,” Manson says. “We see single injuries to single organs and then we see people who’ve had one blade go through multiple organs.”
Some penetrating trauma patients make it to hospital in an extremely fragile state and surgeons have to adopt a strategy that originates from Navy warship emergency repairs called “damage control”. Essentially, this means stopping the blood loss to keep the patient alive and then coming back to them in 48 hours when they are in a better physiological state to tolerate repair work.
Blood products, including transfusions of plasma, platelets and cryoprecipitate, are usually the first step as soon as people arrive in the emergency room. Severe injury causes a defect in the blood clotting mechanisms, just when the body really needs them most. “Your body lets you down,” Manson explains. “It’s called traumatic coagulopathy.”
And if a patient is “actively bleeding” transfusions alone will not help. “You can never fill somebody up if the tap is open on the bath,” Manson says, and explains that surgery is needed to stop the bleeding and restore circulation.
The decision then to “fix” the damage is not entirely straightforward though. “We need to weigh up the injury burden and the wellness of the patient,” Manson says. “So how much blood they’ve lost, how extensive the tissue damage is, what sort of resuscitation strategy we need to use. It requires not just surgeons, anaesthetists and emergency room doctors but also blood bank staff, porters, intensive care, theatre, radiology and nursing staff. It’s a whole hospital system that’s involved in trying to salvage patients with such severe injuries.”
Sometimes several operations are required. Manson witnessed an alarming trend where this became the case for multiple patients and for what seemed to be an utterly disturbing reason. “We often see buttock stabbings,” she says, “and these can be deliberate attempts to cause bowel injury. This can need surgical stoma formation (where the bowel is brought out of the abdominal wall and waste diverted into a colostomy bag), making them a more serious, life-changing event.”
She makes clear that surgeons only see the results and can’t prove the motives behind stabbings, but hypotheses that the trend came about after young people were exposed to well-intended educational materials designed to explain the horrific consequences of injuries. “I don’t have the evidence but it appeared to become a target because they’d learned that was what happened,” she suggests.
Regardless of where they are on the body and the damage, all wounds caused by sharp instruments, Manson says, are savage. “They require a blow that a perpetrator has to physically deliver in what are likely to be emotionally charged, angry, upset, frightening circumstances.”
Will Flint, 28, who was stabbed 12 times in Birmingham in the early hours of New Year’s Day last year when he tried to help a young woman who was being attacked, uses a chilling analogy to describe what that feels like. “It was happening like a sewing machine,” he says, “before I knew it I’d been stabbed. How quickly you can stab someone that amount of times... Bang, bang, bang, bang, and it’s done.”
The attack left Will with a punctured lung, severed spleen and diaphragm and lacerated stomach. He needed four hours of emergency surgery and 60 to 80 stitches and staples. Relentless pain and loss of sensation from nerve damage are just some of the complications that will now stay with him for the rest of his life.
“Eventually they told me I’d also lost a lot of function in my left lung and my diaphragm was paralysed so I can’t breathe fully from my left lung,” says Will, who’s developed exercise-induced asthma too as a result. This news was devastating to someone who had a promising fitness career on the cards and had competed internationally.
Will grieved for the loss of the life he’d lived before the stabbing, and experienced depression, PTSD, anxiety and flashbacks. He had counselling and channelled much of the emotional trauma into exercising, writing music, starting a business and talking to close friends. “I had to overcome and accept quite lot,” he says.
However, not all victims feel able to talk about the feelings they’re left to grapple with. Max Morgan* was stabbed in the chest, back and legs during a scuffle in north London in 2006 when he was 16. He recovered well physically, but the psychological wounds proved much harder to heal. He says he was in “a pretty bad way” for many years and self medicated by smoking “loads of weed”.
“I’d smoked socially before but it went, almost overnight, from that to smoking every morning a big fat skunk spliff on the way to school, morning break, lunch break, after school,” Max explains. “I did that for four or five years. It removed the ability to think about things so much. But that meant I never came to terms with it and that manifested itself in a very strange sort of paranoia when I was 19 or 20 years old.”
He describes feeling as though he was in immediate danger where people around him meant him harm. “I just removed myself,” Max says. “It was a weird sort of agoraphobia. It took a few years for that to drop off. Perhaps I’m still feeling it to this day but it’s not noticeable anymore.”
The emotional impact on victims can persist for an inconceivable length of time. For Jessica Knight, the mental and physical health implications are something she continues to live with today a decade after she was stabbed in an unprovoked attack in Chorley as a 14-year-old.
Her story is astonishingly stark. She was stabbed 22 times in the arm, neck, stomach, face and back, and left for dead. She spent more than a week in a coma and underwent extensive surgery over a number of months. When she woke from the coma, doctors discovered she’d also suffered a stroke, caused by the profound trauma her body had sustained.
Visual disturbances, memory problems, persistent nerve pain – which she describes as feeling like plunging yourself into an ice bucket – down the entire left side of her body, sore joints and impaired dexterity have all become part of the fabric of her life.
Jessica was diagnosed with PTSD and anxiety. She was also too unwell to take her GCSEs, which flattened her dreams of a career in the creative industries – some of her remarkable paintings and illustrations hang on the walls of her home. But it took years for the realisation of exactly how harmful the attack had been to fully emerge and that triggered a dark period in her life.
She attempted suicide twice, the first time when she was 20 and again the year after. Ultimately, she was sectioned and spent two weeks in a psychiatric hospital, where she was on suicide watch. “Everything seemed hopeless,” Jessica says. “I didn’t realise how the attack was going to affect my future. I didn’t even see it coming. I was having mini breakdowns.” She now feels hopeful and has started an interior design course.
Jessica explains that she might not be alive now if it weren’t for a passing cyclist who spotted her and called an ambulance. “They said another five minutes and that’s it, no chance. I’d be dead.”
Time is the nemesis for victims of knife attacks. It is the enemy for the medical staff treating them too, Manson says. Surgeons used to talk about the first golden hour and now they have a platinum 10 minutes to deliver treatment to improve the chances of survival.
“Everything is against the clock,” she says. “The speed at which you stop somebody bleeding to death will alter their outcome. The more blood you lose, the more multiple organ dysfunction you get, the more your body has to recover from.”
That small window, Manson says, is why stellar pre-hospital care from the London Air Ambulance is vital and is perhaps the reason why more critically injured people make it into hospital. Helicopters carry blood and the doctors can perform extraordinary procedures at the roadside.
This can include massaging a patient’s heart with their hands, which requires the chest cavity to be opened using a technique called a clamshell thoracotomy – the name makes it easy to visualise how this works. Ambulance crew can also place balloons in the body’s main blood vessel using a technique called REBOA to reduce blood loss in the abdomen. “It sounds quite extreme,” Manson says. “But if patients are effectively dead, but only just, quick intervention can salvage them.”
But despite best attempts, not every patient can be saved and surgeons have to deliver the shattering, painful news to devastated relatives. Manson remembers every one. “There is a period of reflection, wondering whether we could have done something differently,” she says. “What can we do better next time? Sometimes it is emotional. I’m only human. But for us, life goes on, we have a job to do.”
As our understanding of how the body works and how it can be better fixed continues to advance, the hope is that the job involves less tragedy. Manson is currently conducting research about the innate immune response to traumatic injury at the Barts Centre for Trauma Sciences. “We’re looking at molecular mechanisms, cells and genetics to see if we can unlock the key to multiple organ failure development and make people recover more quickly.”
But all the hurt caused by knives could be eliminated if people decided against carrying them in the first place. Ricky, Paul, Will, Max and Jessica would not have to bear the indelible etches left on their lives by the appalling attacks if the perpetrators had chosen not to carry a blade.
Danny Corbertt*, 14, experienced what he describes as a minor slash on his arm, has had knives pulled on him multiple times and lost one of his friends to a stabbing. He is also currently on tag for carrying – but has now stopped. “I didn’t carry a knife out of no other reason than fear,” he says. “Nowadays it’s never a fist fight. Knives start a cycle of bullshit and it’s hard to get out of it so you carry for fear of your life.”
So how do you make young people, who are frightened for their lives, give up the weapons they believe are keeping them safe? Will believes multiple elements need to be challenged, including weapons manufacturers and social media, to address the crisis.
“The psychology behind carrying a knife is completely misplaced,” he says. “Take America. They think that everyone having a gun solves gun crime and look what’s happening there. It doesn’t work. The last thing a knife is going to do in any situation is protect you. It’ll cause you to lose the best part of your life, either in prison, in hospital or in a grave.”
Watch VICE's new film:"London's Knife Crime Emergency: ON A KNIFE EDGE".
With thanks to Anti-Knife UK and Drop The Knife
*Some names have been changed to protect the identity of interviewees.