Kerry Maxwell is currently an ST5 in Geriatric Medicine working in Craigavon Area Hospital. She has an ongoing interest in poetry and literature, which she studied prior to entering a career in medicine. Her twitter handle is @DrKMaxwell
We can’t go over it.
We can’t go under it.
Oh no!
We’ve got to go through it!
So runs the refrain in ‘We’re Going on a Bear Hunt’ by Michael Rosen, a classic so many of us have enjoyed with our children. When he became ill with Covid-19, for Rosen, as for the many, many others who have faced into the fearful uncertainties of this disease, there was no choice but to ‘go through it’. His journey was not an easy one. Forty-seven days in intensive care were followed by a long and painful process of rehabilitation and re-adjustment.
From the experience has come ‘Many Different Kinds of Love’, a chronicle in prose poetry, and, for healthcare workers during the pandemic, a remarkable insight into what it feels like on the ‘other side,’ as an NHS patient.
The writing is characteristically unfussy and direct, even humorous at times; straightforward in a way which sometimes belies the profoundness of what’s being said. There is much there to reflect on for those of us who care for older people in particular.
There are musings on polypharmacy, the absurdity and the richness of medical language, and the strange camaraderie between patients from different backgrounds sharing a ward. Rosen bears witness vividly to some of the small humiliations the institutionalised ward environment can visit on patients, such as when an overworked nurse on nightshift is unable to bring him a bedpan in time. His shame in this situation makes uncomfortable reading.
The book is very revealing in general about the psychological effects of illness and physical dependency, as well as medical environments and interventions. There are the noisy, sleepless nights, ‘long and sad’; the unsettling sounds of other unseen patients ill or in distress; and the constant observation rounds to update the ‘ledger telling/ the story of all my up and downs’ creating the feeling that he has ‘become an account’. ‘My body has become theirs.’ Rosen concludes.
The rehabilitation process, however, allows him to gradually claim back that agency and independence. One thing dramatised very memorably in this account is just how hard it is to do the work of rehab, both mental and physical. ‘It takes brain work/ to stop saying, ‘Help me’,’ Rosen acknowledges, as he tries to ignore the siren call of his hospital bed which sings to him: ‘Come back./ I’m here for you’! When progress is hard and slow, it is the physio- and occupational therapists who have to see further ahead on his behalf, to expect from him what ‘feels … way beyond what I’ll ever do’.
Indeed, despite the hardships of being a patient, the theme from the book’s title runs through every page: the sustaining power of many different kinds of love, both from Rosen’s wife and family and from those professionals who look after him. We don’t usually tend to think of caring for patients as a kind of love, but comparing the care he received from the staff in intensive care to a parent sitting by the bed of their sick child, Rosen writes: ‘I try to fathom this devotion’. Touchingly, the ‘Induced Coma’ chapter is made up almost entirely of messages the intensive care staff wrote in a diary beside his bed while he was unconscious or delirious.
It’s clear from Rosen’s account how the journey of illness, recovery and rehabilitation is one which affects his identity and sense of self very profoundly. He struggles to define himself according to his functional abilities. ‘Maybe I’m a wheelchair person,’ he thinks early on, then later, envisaging using a Zimmer frame, ‘yes, maybe that’s me’.
Towards the end of the book, having made it home and made it out to do the shopping on his own for the first time, Rosen makes a tentative bid to finally shake off some of the psychological effects of his illness and his time in hospital:
accounts and ledgers
Only notice gains and losses
not differences.
… couldn’t I make an effort
to think I’m not a ledger?
I am what I’ve become?
And it never stops:
we are always becoming.
Perhaps this is a way we could try to think about our patients. Regardless of who they may have been in the past, of losses and gains, of differences, that person we care for is both whoever they are in that moment, and at the same time ‘always becoming’.
