Your mum is medically fit.
Jane is medically fit.
Old man Abe is medically fit.
Can you be un-medically fit?
To be fit must a doctor be involved?
Medical fitness is a 21st Century invention.
I am certain it wasn’t a subject covered at medical school, nor as part of the Royal College exams.
Who is medically fit, A, B or C?
You see, the big thing about being medically fit, is what it means in the context of modern-day medicine. It in effect translates as, ‘No longer needs to be in hospital,’ which, in the current world means, ‘Home.’
The problem arises predominantly for older people, when the gauntlet of ‘home’ is thrown-down within the hospital system. Home… Off you go. Taxi!
Because of the pervasive, overwhelming protectiveness and, likely, defensiveness of the NHS, ‘home’ doesn’t always mean, ‘home’
Home, but you are not felt to be safe to climb up and down your stairs, home, but you cannot wash or shave or put your clothes-on in an acceptable time-frame or manner; home, but you sometimes trip, stumble or fall on the way to or from the kitchen or living room.
Home, is grey.
Home and medical fitness are ideals. Pickett fence and apple pie.
Fall over, ambulance, A&E and, before you know it, tests and analyses, capacity assessment, tricky questions about competency, who is the Prime Minister, where are you and, which war is currently being fought in the Middle East?
We don’t make it easy.
And medical fitness is a little like a golden fleece.
Un-fit and the social workers and discharge folk can’t touch you. You can relax. Lounge in your hospital bed, enjoy the scenery. When medical fitness approaches, when it is written in your record, the process of detachment begins, Bowlby would have a hay-day.
And yet, my mum, she doesn’t seem right, she is still losing weight, unable to walk or toilet herself, she has a cough and occasional pain in the chest, how can she be? How is this fitness?
One man’s fitness is another’s morbidity.
Not in imminent decline.
No need for thermometers and blood tests, or special manoeuvres to change your position in bed. You are your own person, society, or ‘the social’ takes over.
But… my mum, she doesn’t seem right.
Yes, your mum is dying, but, she doesn’t need the hospital right now, she doesn’t appear to be in the last days or weeks or months of life, she can keep on going for a good while yet, just, not here, not on our watch, on our hourly rounding or observations.
Let’s move forwards.
No good comes of hanging around, lingering in one spot.