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 recuperation, that have now been closed or redeveloped for other purposes. When I was a medical student at a London teaching hospital patients were commonly transferred, after 10 days in hospital for removal of a gall bladder or some similar operation, for another couple of weeks of convalescence at a seafront hotel in Clacton. These days it seems that you can have a heart transplant and expect to be home for the weekend, at the tender mercy of an NHS phone line.
I recall that when I was a junior hospital doctor in obstetrics, women were expected to stay in hospital for at least a week after childbirth. This was becoming increasingly unpopular with mothers having their first baby, but was much appreciated by those who already had young children at home, especially those in less affluent circumstances. Now stays in maternity units are measured in hours rather than days, even after caesarean section deliveries. In his thoughtful reflections on the changing culture of medical practice, Dr Francis wonders whether the anti-institutional pendulum has swung too far away from the traditional role of the doctor and the hospital in the relief of suffering as well as in the restoration of function.
The pandemic has brought renewed attention to the management of persistent symptoms of fatigue and debility as well as the treatment of acute illness. Because “everyone has a different tempo of convalescence” patients with long Covid will require different strategies to assist their recovery, “pacing” themselves according to their symptoms of breathlessness or exhaustion.
The tempo of convalescence is dramatically at variance with the culture of urgency that prevails in contemporary medical practice, which emphasises “rapid access”, early diagnosis, fast-track treatment, and the vigorous rehabilitation of the gym rather than the restful recuperation of the seaside hotel.
Dr Francis acknowledges both the benefits of scientific medicine and the disappointments of both patients and doctors at its limitations. He recognises the paradox that while categorising illnesses offers some comfort it can also “offer a false sense of definition, locking us into an expectation that becomes self-fulfilling”. He concludes that “the most helpful approach is not to think of illness categories as concrete, immutable destinies but as stories of the mind and body. Within limits stories can be rewritten.”
Recovering the lost art of convalescence would do much to address the current crisis in relations between doctors and patients.
What’s in a name?
“Call me Kish.” This was how a young man introduced himself after knocking on our door canvassing for votes in the local council elections. His explanation – that everybody called him Kish, as his full name was Kishore Kukendrarajah – seemed entirely reasonable. I was intrigued to discover that, in addition to campaigning for election to Haringey Council, he is a cardiologist at Barts Hospital.
I later discovered a letter in the BMJ, the medical profession’s woke weekly, proposing that “one small thing we can all do” to challenge “the racism that clearly exists in the NHS” would be “to stop anglicising or abbreviating colleagues’ names”. I wondered whether Kish had noticed this.
My Irish mother used to complain, when people referred to me as Mike or Mick, that this was a manifestation of English anti-Irish prejudice. Both my grandfather and father were named Jeremiah, which was once popular in Ireland but considered exotic in England and was hence reduced to Jer or Jerry. As a gesture towards assimilation, my elder brother was christened Jeremy, a compromise that, according to my father, pleased nobody.
A younger generation of Irish parents have found a way of getting their own back on their erstwhile colonial masters by naming their children in Irish, with names like Saoirse, Caoimhe and Aoife, which are both unpronounceable by English people and not easily abbreviated.