In just over two weeks, my mum has shifted from the agonised, unhappy and vulnerable alien state in which she was admitted to the hospital. Now she shares details of the lives of the staff with me, and speculates about where the real world starts and ends in this hospital. She has been wondering about the effects on the staff of working long shifts on the orthopaedic ward. I have observed that, with the exception of one acute mental health inpatient ward, my hospital jobs always included an occupational therapy department to retreat to. I don’t know what it’s like, really, to spend most of my working, waking hours in a green and cream, strange smelling ward, which beeps and buzzes relentlessly; not with hi tech machinery, but with people buzzing for help. In the occupational therapy department, vulnerability was not so evident, in that insistent, help me now! way.
This shift from painful terror to the current optimism, the night before her discharge, has preoccupied me. Initially there were so many questions that no one could be sure they were doing the right thing. Her vulnerability and acute desire to be anywhere else were all too evident and caring procedures offered little relief, being confused by morphine and medical mysteries yet to be solved. What could we do? I made some tiny scones, to tempt her to eat. I didn’t anticipate the nil-by-mouth sign or the guilt associated with eating them myself, because she couldn’t. Much of my hospital visiting has been as much about my needs as it has been about hers. I needed to see her, to be reassured of progress, to bring the outside (real?) world in. Last night she sniffed my hair and smelled the outside world, at the end of a warm spring day which could not be perceived from her bed. Meanwhile I have told her about my everyday life in great detail: so satisfying to have her there, listening. These evening sessions have refreshed a longstanding professional reminder-to-self: if these people weren’t ill/disabled/in crisis, there would be no job for me. No income, just remember you need them. So are we all vulnerable? Without you, patient service user, I have no job and no income. Do I need you more than you need me?
Occupational therapy has historically subverted this vulnerability with its emphasis on getting people to do things, to be independent. This is despite the supposed cultural critique of the notion of independence (is it individualist to want to wipe your own bottom?); and the dangers of coercion when it comes to getting people to do things, especially for themselves when they are sick and tired and yes, vulnerable. It is possible that I have turned a blind eye to vulnerability. But I wonder now, seeing my mother’s shift, whether the positive occupational therapy focus on capacity for, rather than just actual, performance mitigates vulnerability. And doing things is intrinsically empowering, or it can be.
There was quite a shift in focus the day the occupational therapist got involved: my father was given a checklist of measurements to take once he got home, of furniture, steps and stairs. My mum was able to talk about her life at home and what she hoped to do. Primed with hope from attention from the orthotist who fitted her spinal brace, and from first steps with the physiotherapist, she seemed to gather momentum for her recovery. With the prospect of discharge, paradoxically she seemed to be less alien in the ward, as if time and her recovery had made her more able to belong there. Now she can connect with the nursing and support staff, permanently on the ward and doing, in her eyes, the thankless tasks. And I guess that seeing my mother’s transformation is a rewarding aspect for them: her fear has disappeared and is replaced with an interest in them and their personal lives. I won’t miss my hospital visits each evening. I’m ready to catch up with Call the Midwife, and think again about vulnerability and alienation.