Isolation

The impossibility of not thinking

The last week…or not….starting December 4th

When I run a workshop on communication, I have to get people to understand that they are in a constant state of communication. You may or may not be talking, but you speak volumes, even in your silence. My current state amounts to solitary confinement – being the sole occupant of my room and only able to have limited exchanges with people who have no practical knowledge of my language. While I have a working knowledge of Italian, the local Umbrian accent is about as impenetrable as the Glaswegian dialect would be to a Milanese sophisticate. What I have come to realise is that I cannot escape the tyranny of thought; I can’t switch off, stop thinking or drift away, and while part of this stems from boredom and lethargy, part is also medical, or rather it is a chemical response to the use of morphine in post-operative care.

My sister Maggy had warned me that if they gave me morphine after my operation, I should be prepared for some challenging after-effects. This was confirmed in a radio programme I was listening to through my computer last week, when David Aaronovich – a highly respected journalist and author – described his experiences in hospital after being sedated with morphine after an operation. He was convinced that the nurses were conspiring to kill and eat him. Aaronovich is not the sort of person to spin sensational fantasies, and he gave me a context for the terrifying nightmares and haunting internal debates that I have been experiencing in the past three weeks, keeping me awake at night and genuinely frightening me with the lucidity of the arguments that the dreams presented.

There was something of science-fiction scenario in waking up after my operation to find a piece of laboratory apparatus taped to my arm and linked to a feed into my vein. There was a glass tube containing a small sausage-shaped balloon – presumably the reservoir of morphine – which gradually deflated over the next couple of days. From what I could understand from the labelling it was a controlled-release 48-hour dosage. I certainly had very little pain, despite the scale of the operation, but I was uncomfortable at the idea of chemicals being drip-fed into my system constantly for the next 48 hours.

Since then, I have found myself lying awake, challenging every aspect of my existence and every facet of my lifestyle. While I have not had fears that the nurses were cannibals, I have been convincingly persuaded that my children and all those near and dear to me were simply putting on a pretence in their relationship with me. What was worse was that the arguments that developed in my brain were totally logical and perfectly reasoned and I could find no way to refute them when I awoke – if I ever did manage to get any sleep in the first place.

To confuse things further, a month away in the solitude of a hospital does focus the mind and does create the opportunity for serious re-evaluation of one’s life, lifestyle and purpose, in the way that a walk in the woods or a stroll along the beach simply does not allow. I have found myself confronting some pretty serious issues and I struggle to reach any conclusion as yet. But I refuse to go down that depressing road at this time; I think I would rather highlight some of the more amusing aspects of life in the Rehabilitation clinic.

Friends and Family

Moral support from back home

The most noticeable difference compared to British hospitals is the attitude to visitors. The whole Italian concept of family means that both at Foligno and here at Trevi, it’s not unusual for a close relative to simply move in and sleep in an arm-chair or sun-lounger next to the loved one. The nursing staff don’t seem to object because in such cases the patient often needs above-average care and the permanent presence of a family member makes life easier for them. A strange community evolves, with patients and their families mingling, comparing notes and gossiping. I'm surprised there aren't Primus stoves cooking up Nonna's favourite recipes.

Then there are the duty visits. The daughter of an elderly parent or relative arrives for the evening meal and keeps the patient company. There is no conversation, just a ritual vigil which ends with clearing the table and washing-up the cutlery (we all bring our own in Italy,) then a mumbled farewell till the next day. A variation on this is the fussing wife who tucks the napkin into her husband’s shirt collar, cuts up his meat, sprinkles the salt, chops up the salad and dresses it with oil. In extreme cases she will even spoon-feed him if he throws a tantrum. At least this provides some light relief on the male table, which is generally dominated by dour silence punctuated with the occasional grumbling remark about the quality of the fare, and the generous sharing of the newly harvested olive oil that each has brought from his own garden and which are individually compared and contrasted with epicurean analysis.

Even in hospital, appearances are all-important in Italy. The ambulance men delivered a new patient yesterday, wheeling her along the corridor strapped lying down on a trolley. Her hair was perfectly in place and she was wearing full make-up, lipstick, mascara, eye-liner, the works. She clearly wanted to be prepared for whomsoever she might meet along the way. Either that or she didn't trust the undertaker to do a good job if anything went wrong with her treatment.

There is no restriction on the use of mobile phones, and if there were then I imagine such a regulation would be ignored. The early evening is a cacophony of ringtones as most calls are missed or ignored.  Some of the older patients have been presented with a basic Nokia mobile especially for their stay in hospital, with the inevitable result that the phones are on factory settings. Consequently that infuriating Nokia signature tune will blast out at full volume while the aged relative first tries to locate the phone and then to work out how to answer it. Having missed the call there is then a slow punching in of a family phone number digit-by-digit since such niceties as “phone memory” and “call-back missed call,” were not explained by the kind-thinking offspring when they donated the device. Actually the operation probably was explained in great, complex detail - and rapidly forgotten. When the calls are made on these new-fangled mobiles the vocal communication is carried out fortissimo in the certain belief that the only way to be sure of getting a message through on such a tiny piece of technology is to be on the safe side, and shout.

The Integration of Shrek

Size matters

Of course, the biggest joke at the clinic is yours truly. I don’t think the locals have ever seen a full-size human male before, and I must have been asked my height at least a dozen times. There are some huge mirrors in the exercise room, and when I catch a glimpse of myself with one of the therapists, I crack up. It’s Shrek! – No question about it! I loom over everyone. I dwarf the therapist working with me and my feet hang off the end of the massage tables. My wheelchair has been taken apart and reassembled with extra bits to add width, depth and height and, of course, the jokes are endless. I think they assume that because they now have Shrek in their midst, they should be entertained by an oversized buffoon. I try to melt into the background, but – as Shrek himself would tell you – that’s easier said than done.

You’ll be pleased to know that I am making a major effort to integrate, but the men don’t speak to each other or even to themselves apart from the occasional grunt, and the women just gossip about whatever was on television last night – Italian X-factor or some complicated game show involving huge sums of money that are painfully won and then cruelly lost. If only I spoke better Italian we might perhaps discuss the Milan opera, the education system or the plight of the Euro. But somehow… I don’t think so.

Doctor’s verdict

Wednesday December 7^th

It was time for my dressing to be changed when the doctor did his round this morning. Everything is healing up perfectly and the layers of gauze and tape have now been replaced with one modest Elastoplast covering the final inch or so of the wound. He set my discharge date for Saturday December 17^th which will make my total stay just over 5 weeks in the two establishments, divided between the orthopaedics department of Foligno hospital and the rehabilitation clinic here in Trevi. Meanwhile, I am still strictly confined to my wheelchair except for short, escorted excursions with crutches, up and down the corridor as part of my therapy sessions. It is starting to make me a little nervous because I’d like to feel more competently independent, but all I can do is put my complete faith in the specialists and see how it all pans out. I secretly hope they are going to banish me from my wheelchair at the end of the week so that I have a full week of relative independence, managing with my crutches, before I go home.

The limited internet access is annoying. I have a dongle that plugs into the USB port on the laptop, but the signal is weak and intermittent. By using a remote LAN that fools the BBC into thinking that I am in Maidenhead I can access BBC and BBC i-player, but it is rare that there is sufficient broadband capacity for a reliable connection. Last night I was watching Young Apprentice, and it got to the when Lord Sugar was about to fire one of the contestants when the screen froze and the “insufficient bandwidth” message appeared. There is however plenty of capacity for downloading radio 4 and I have a library of Midweek, In Our Time, Saturday Live and Thinking Allowed that keep me entertained.

But who did Sugar choose? – the nice guy or the feisty girl?

Gynaecological Miscalculation

Thursday December 8^th

I slept slightly better and was up and ready in plenty of time for the first session in the Exercise Room, - so early in fact that the doors were still closed when I wheeled down the corridor. It was suspiciously quiet so, wondering whether my watch had stopped I headed backed towards my room only to be met by the breakfast nurse gesticulating and laughing. ‘No, Santa Claus!’ (She has dubbed me Santa Claus as being more appropriate and slightly less offensive than Shrek.) ‘Oggi e festa, no palestra oggi.’ Today is a festival, no exercise room today.

And then I remembered something Fi had said when she’d driven the 200 mile round trip to bring me clean underwear yesterday. December 7^th is the Feast of the Immaculate Conception, and it’s an Italian public holiday. Now, I know I’m only a bloke and not fully conversant with all aspects of childbirth but after fathering a substantial Harvey clan I do know that December 7^th – December 25^th is not a realistic full-term human pregnancy. I’m not sure that it’s even full-term for a mouse or hamster, come to think of it. Of course, it is J.C. we’re talking about here and so maybe we are not looking at a normal human confinement, though I have always had the impression that Mary was pregnant in a visibly human way and the mystery was how she got herself into that condition, not whether or not it was otherwise conventional.  Perhaps this 18-day pregnancy is all part of the miraculous, immaculate bit, but frankly, I don’t think that washes and I’ve seen nothing about it in the Gospels nor ever heard about it in Church. If my dongle were more efficient I would hit Google and probably come up with some really interesting research about the Council of Constantinople or a Papal Edict of 1124 A.D. but I can’t get that worked up about it. I’d rather sit down with some village priest and make my point that it’s all very silly and just an excuse for getting the congregation in practice for Christmas. It’s a bit like Harrods opening Santa’s Grotto in August when they can catch the long-haul tourist market. It’s faintly embarrassing and decidedly inappropriate.

Locked out of the Exercise Room

An excuse for a coffee break

So there it is. Another day with no physiotherapy: no leg-stretching, back-bending or toe-curling. Instead there is a constant flow of nurses and fellow-inmates putting their heads around the door and asking me why I am working, as if the only possible reason for writing were something to do with work…. And then a pleasant surprise when a different head looked in at the door.

One of the less elderly inmates is Lisa,– I imagine in her 30s – who, like most of the residents is wheelchair-bound and who wears a frightening piece of moulded plastic body armour that holds her upper body rigid. She appeared at my doorway while I was writing and asked if I fancied a coffee as she was heading off for one and wasn’t allowed to go alone. I had no idea that coffee was available anywhere, nor that we were allowed to leave the 2^nd floor, but apparently we are allowed access to the ground floor as long as the nursing staff know what we are doing and we do not go alone. Imagine my feelings after 28 days of incarceration! Five minutes later I was over the moon, sitting in my wheelchair in the courtyard in the bright winter sunshine, enjoying my first cup of coffee since dinner at the hotel in Foligno four weeks ago.

Lisa is in much tougher plight than I. She was in a serious car accident in the summer and has been in the clinic since mid-September. In January she will have further surgery but there is no clear prognosis as to how things will turn out and she is likely to be back in the clinic for much of next year. She told me how she had trained as a ballet dancer and then built up a successful career as a television journalist… now she just has to live from one day to the next.

We were talking about the tough regime at Trevi, and also about the fact that they do not rush to get patients on their feet and mobile. The whole emphasis is on getting the muscles and the nerves working properly before putting them into practice with standing and walking. We were both describing the awful sensation of impotence when you try to move a limb and the body offers no response. I will lie on my back in a physio session and the therapist will tell me to raise my left leg – the one that was operated on. Try as I might, I can manage no more than a mild twitch, and even when the therapist takes some of the weight the exercise feels nigh on impossible. I can best describe the sensation by comparing it to a marionette with one or two strings no longer connected to the puppeteer. It is not so much painful as just blank. Nothing happens, there is no sensation, just a total disconnect between the brain’s demands and the limb’s response. It is this that I most want to overcome, because it engenders a quite terrifying sense of impotence and incapacity.

But then I look at someone like Lisa. Clearly from her dance training she will have been in total control of her movement and coordination before the accident; she now has no idea what the future holds for her. How can I possibly complain about spending 4 weeks here when she faces the prospect of spending most of 2012 here with no certain future for her life stretched out ahead of her? Slipping out for a coffee this morning gave me far more than fresh air and a reviving brew, it put a lot of things into perspective.

The other thing we talked about – as people always do in a hospital environment – was food. For anyone who likes food, eating in hospital is a pretty awful experience. I try to remain positive, and at least with today being a nationally recognised Feast Day, there was some improvement. A little lasagne, followed by slices of roast turkey with a light gravy (we will gloss over the accompanying sprouts.) Then there was a custard-filled pastry, a piece of fruit and a banana yoghurt. Not great, but way better than the usual fare. Lisa is fortunate in having her support team of friends and relatives who supply her with packed lunches and suppers; I don’t think she could possibly survive months here on the regular offerings.

Stoicism is not normally perceived as an Italian characteristic. Lisa exemplifies a calm inner strength and her fortitude and attitude have left me humbled and in admiration.

 I must stop complaining; I am the lucky one who knows when I’ll be leaving and that I will be fully recovered in a relatively short period of time.