Earlier today I watched a TED video by writer Andrew Solomon about his experiences with depression. It is a mesmerizing performance from someone who is both stunningly articulate and strange. Solomon describes his experiences with depression and one of the most significant moments in the piece relates to him discussing the idea that depression is something ‘normal’, something that it is OK to live with, to put-up with until it has passed; not a disease that needs treatment, but part of the human condition that we need to live-through.
Solomon alludes to the potential waste of time a person spends waiting for their depression to lift – ‘life is short, and even for someone who is 37, a year is too precious to waste’
This brings my patients into sharp focus.
Today, on my ward, of the 16 patients, I was able to identify 15 who did not need to be in hospital. A couple of them were scheduled to go home within the next 24 or 48 hours, the majority were stuck in a timeless limbo that is hospitalisation.
Some of my patients enquire of me each day as to when they are getting home – over the years I have developed a multitude of euphemisms to cope with such situations, for example, ‘we are getting you home…’ or, ‘I’ll ask sister when you can get home,’ or even, the outright egregious, ‘I’ll see what is happening to your transport’
My patients, most of whom are in the last years of their lives, spend precious days and weeks waiting to get home, waiting for release from hospital, either because of issues relating to the provision of adequate social care aka ‘carers’ or worse still, the decisions of anonymous financial ‘panels’ that either sit at council house or in the local clinical commissioning group – collectives of individuals who have to determine how best to spend public monies based upon information gleaned in a so called ‘fact-find’ – a health or social care review of dependency.
I find it painful to look at my old, usually frail, vulnerable patients spending the sometimes precious last days of their lives in hospital. Sure, we try to make their stay as comfortable as possible, we try to entertain them, make them feel welcome; support their period of patient-hood. More significantly, we try to minimize any harm which might affect them – falls and pressure ulcers, dehydration, institutionlisation and malnutrition.
How would I feel if I was trapped in a health and social care system that to all intents and purposes appears to be in its death throes, allocating finances and resources that have already been spent? How would I feel if I was depressed, watching the passage of moments, the rise of the sun and the transition through day to night inside a hospital ward, having to obey, to comply with the health and safety regulations that would otherwise drive me crazy.
What do I do when I can see my mother or father in the custody of a health service that is running in circles, trying to provide something that is no longer attainable?
Balancing the priorities and expectations of depression and hospitalisation, it is difficult to determine which is more significant, which has a greater influence on how I will spend the rest of my days – devoid of privacy, of autonomy, of independence, or locked into an echoic world that resonates through my head, reminding me that I am no good, and life isn’t much better.