I want to make you old and dependent.
Today, at a meeting* we were discussing some of the not so good things that happen to older people during their transition from person to patient.
Very little has to change existentially for this shift to occur; occasionally the happening will be significant – broken hip, heart attack, cancer; at other times the transition can be more trivial – a trip, confusion or flare of arthritis.
The possibilities are endless.
Infected toe/diarrhoea/constipation/breathlessness/disorientation////you get it…
How though, do you take someone, perfectly fit, independent and well and make them into something else? How do you diminish their essence? Marginalise their autonomy?
The NHS has a tried and tested technique; it is called hospitalisation.
If you like, you can purchase a bundle. This, in safety culture is a compressed list of instructions, tools or equipment; all you need, to do what you have to do.
Here it is:
- Take away the person’s name; Rod Kersh becomes the old guy in bed 17.
- Change the individual into a disease; the guy in bed 17 with a fever.
- Lose Rod’s glasses, dentures and hearing aids.
- Take away his leg bag and replace with hourly urometer (that should keep him tethered.)
- Dress Rod in outmoded pyjamas or
- If 5) is not possible, use hospital pyjamas, or,
- For extra effect use hospital gown (preferably open at the back).
- Provide sippy-cup for hydration
- Remove pants and trousers and replace with adult nappy aka continence aid
- Wrongly time medicines for Parkinson’s disease / write ‘not available’ next to the Madopar/Selegeline/Ropinorole
- Ensure the difficult to manipulate nurse call alert is out of reach of Rod as his delirium increases
- Make noise (ideally at three in the morning)
- Turn lights on then off;
- Move beds or wards at four in the morning – this is the perfect witching hour for disorientation.
And, there you have it.
Few are able to resist this process; the shift of day to night, the evaporation of autonomy.
Not quite the mixture required for baking a cake, more, the concatenation of circumstance that is today or tomorrow in the NHS.
*Thank you Adnan for the inspiration!