In his new book, Recovery: The Lost Art of Convalescence, Edinburgh GP and writer Gavin Francis recalls local hospitals, sanatoriums and asylums, where patients were once admitted for rest and recovery, that are now closed or being redeveloped for other uses became. When I was a medical student at a teaching hospital in London, patients were usually transferred after 10 days in hospital for a gallbladder removal or similar operation to a seaside hotel in Clacton for a few more weeks of convalescence. These days it seems you can have a heart transplant and expect to be home for the weekend, at the tender mercy of an NHS phone line.
I remember when I was a midwifery resident, women were expected to stay in the hospital for at least a week after giving birth. This became increasingly unpopular with mothers having their first baby, but was greatly appreciated by those who already had young children at home, particularly those in less affluent backgrounds. Now, stays in maternity wards are measured in hours instead of days, even after cesarean births. In his thoughtful reflections on the changing culture of medical practice, Dr. Francis whether the anti-institutional pendulum has strayed too far from the traditional roles of the physician and hospital in alleviating suffering and restoring function.
The pandemic has brought renewed attention to treating persistent symptoms of fatigue and weakness, as well as treating acute illnesses. As “everyone has a different pace of recovery”, long Covid patients need different strategies to support their recovery by “tuning” themselves according to their symptoms of shortness of breath or exhaustion.
The pace of recovery is in dramatic contradiction to the culture of urgency pervasive in today’s medical practice, which emphasizes “quick access, early diagnosis, prompt treatment, and the vigorous rehabilitation of the gym rather than the rejuvenating seaside hotel.”
dr Francis recognizes both the benefits of scientific medicine and the frustration of patients and physicians with its limitations. He acknowledges the paradox that while categorizing diseases offers some comfort, it can also “provide a false sense of definition and lock us in an expectation that is self-fulfilling.” He concludes that “The most helpful approach is to think of disease categories not as concrete, unchanging destinies, but as histories of the mind and body. Within certain limits, stories can be rewritten.”
Recovering the lost art of convalescence would go a long way in addressing the current crisis in doctor-patient relationships.
what’s in a name
“Call me Kish.” That’s how a young man introduced himself after knocking on our door to solicit votes in the local elections. His explanation – that everyone called him Kish since his full name was Kishore Kukendrarajah – seemed perfectly reasonable. I was intrigued to learn that in addition to running for election to Haringey Council, he is also a cardiologist at Barts Hospital.
I later discovered a letter in the BMJ, the weekly awakening of the medical profession, which suggested that “one small thing we can all do” to challenge “the racism that clearly exists in the NHS” is to ” to stop Anglicizing or abbreviating the names of colleagues”. . I wondered if Kish had noticed.
My Irish mother always complained when people referred to me as Mike or Mick that it was a manifestation of English anti-Irish prejudice. Both my grandfather and father’s names were Jeremiah, which was once popular in Ireland but was considered exotic in England and was therefore reduced to Jer or Jerry. As a gesture of assimilation, my older brother Jeremy was baptized, a compromise my father said no one liked.
A younger generation of Irish parents have found a way of taking revenge on their former colonizers by naming their children in Irish, with names like Saoirse, Caoimhe and Aoife, both of which are unpronounceable for English people and not easily abbreviated.