Community Health encompasses so much, from the acute to the chronic, the social to the medical, from the replacement of a single worn ferrule on a walking stick to the installation of a gantry hoist and a small army of carers; from a three day course of antibiotics to months of gruelling IV therapy. Work in it long enough and you’ll see countless variations, each situation particular to the individual patient and their family.
But if I was forced to nominate the one thing that caused the most problems out in the Community, I would say it was a Resistance to Change.
It’s been said before that the only constant in the world – the one thing you can be absolutely sure of – is that things change. And ultimately it’s not the specifics that matter so much as the way you embrace them. Hanging on to things that cannot possibly last, however much you’d like them to, inevitably leads to friction and unhappiness. A hard lesson to learn, of course, and one that needs constant practice and reinforcement, but no less important for all that.
Take Janice and Henry, for example.
Henry is a hundred. A simple expression of fact – impressive enough in itself, were it not for the fact that every night he goes up three flights of stairs to bed.
Janice goes up behind him, of course. Janice is Henry’s daughter. They’ve been living together a good many years, now, and they’ve got their routines. Latterly Janice has taken over the role of principal carer, a guy coming in every morning to help with washing and dressing. Janice is doing a great job in difficult circumstances, changing Henry’s pads, keeping him fed and entertained. They have a lovely relationship.
We’d been called in by paramedics, who attended a non-injury fall here the other day. Apparently Henry slipped out of his leather armchair downstairs, and Janice couldn’t get him up.
‘The footstool slid forward and he sort of jacknifed’ says Janice. ‘It was too early in the morning to do what I normally do, so I had to call 999.’
‘What do you normally do?’
‘I go out in the street and ask someone if they’d be so good as to come in and help.’
‘Isn’t that a bit risky?’
‘Oh no! People are good, you know. And I only ever ask the burly ones.’
‘Has Henry fallen a lot, then?’
‘Half a dozen times. Not falls so much as a gentle collapse. This one was different because he was in a funny position. Generally it happens on the stairs.’
‘About half way. Occasionally his legs just give out. So he’ll sit on a step a while. And if he can’t get back up again, I’ll nip outside and fetch someone in.’
Janice has already given me a tour of the place. One of those rickety old town houses, compressed by its neighbours into a vertiginous, three-storey affair, two rooms per floor, Henry’s bedroom at the very top, the stairs leading up and up and up so relentlessly you don’t need a handrail so much as crampons and a bottle of oxygen.
‘I’m puffed and I’m half his age’ I said to her.
‘You shouldn’t be,’ she said.
We’d skated over the possibility of changing things around a bit. Maybe moving the bed downstairs. Janice was indignant.
‘Where would I sleep?’ she said.
‘I don’t know. Upstairs?’
‘Out of the question!’
‘He’d be safer.’
‘Yes – but… where on earth would I put everything?’