‘In the Room at the End of the Corridor’…….

In prose and poetry, with wit and insight, my Dad has written about his time in hospital following his stroke in the summer of 2016.  I promised him I would post it on my blod and felt it deserved a page of its own.  I hope you enjoy it as much as I did.

I should add that my Dad has sent this far and wide to the NHS organisations who cared for him, charities and others who he felt might be helped by his experiences. It has been interesting to me but deeply dispiriting to him that even a simple acknowledgement of receipt of his letter has been rare.

In  the Room at the End of the Corridor – By Donald A. Denegri

Preface

Nothing I had heard or read about Stroke prepared me for the disruption it caused my life. I found that by writing about my experience I was able to cope with the physical and mental challenges it created. During the twenty weeks I was in the stroke ward, the staff expressed an interest in my literary efforts and suggested that others, ignorant of the dramatic, sometimes overwhelming effects of a Stroke, would be interested too, They also suggested that, as I intended to include a personal account of how I coped with my first few weeks in Strokeland they would be interested in a patient’s view.

These possible uses affected the way I assembled the material. My account of how I coped is based on scattered notes I wrote during my early stay on the stroke ward. Additionally there were important factors that influenced what I dealt with, sometimes singly, sometimes in groups, under the title ‘treatment’. Most of these were drafted during periods of reflection and have been edited since I left hospital. They are simple accounts of what I thought looking back on the events of each day Finally, during times when I felt relaxed, my writing was more creative. The end result is a strange mixture of fact, opinion, report, supposition, fiction and poetry.

As I worked through material from my twenty weeks in Ward 22, I realised  the progress I had made dealing with my condition was achieved in three phases. Phase I was the struggle to realise what was going on. Phase 2 was spent trying to cope. Phase 3. the longest, unexpectedly provided opportunities to be creative. I have given each of these phases a separate section, a sort of chapter, but in reality they developed, each into the next.

The reflections, mentioned above, I have extracted from the pieces I wrote under that title in the ward, amalgamated with brief accounts and comments on what I experienced.  Originally I thought these pieces might be presented formally as appendices but the evidence was too slender and my qualifications not related to the subject matter. Nevertheless, they are based  on the observations, over an unusually long time, by a patient experienced in reporting on performance in similar organisations. What is written here are my personal accounts and views. They have no official  validity but I hope the staff will find the document interesting and perhaps even helpful during their  discussions.

Introduction: Me

Since my stroke I have wondered how the condition selects its victims. I am an octogenarian and managed to live my first seventy years without a major health alarm: mumps, tonsillitis, chicken pox: each took its turn without permission and departed meekly. In my seventies, bowel cancer was no match for surgery.  Consequently I thought I was a  healthy chap with nothing to worry about. It is not surprising therefore that I was ill-health ignorant and health-complacent, aware of lurking conditions such  as cancer and dementia with a rough idea of the symptoms and treatments, but not wise to them. Knowing ‘about’ them seemed to make them less formidable. As a result, when Stroke struck I was desperately naïve. Suddenly I was stranded in a world that did not make sense. Would I have been  better able to cope with the drama if I had the knowledge and understanding of the consequences? That is difficult to answer because Stroke can affect mental1 attitudes making rational thinking difficult, or  in my case, initially impossible. For me, if I had known, the confusion, it would probably have been easier to accept.

The confusion seized me suddenly  One summer morning very early on my way back to bed from the en suite, when I was most vulnerable, my body seemed to crumple; it was as though my muscles had evaporated. I was unable to get up, in itself very frightening. I was a hostage in an upside down world. Hostage? One who is waiting to be released and unaware of how relief could come about. The transfers from home to ambulance and thence to A & E where stroke was diagnosed were prompt and very efficient. From A & E I spent 4/5 days is a care bed and thence Room.23, ‘the room at the end of the corridor’. It was in this room that I adapted myself to a very different life from the one from which I had been snatched. I spent nearly 20 weeks, mostly  in a wheelchair, in that room. What happened to me there is chronicled here.

Ward 22 is the Stroke Ward where all the patients have their own room. Room 23 was constantly described as the best in the ward and is certainly the largest. Its main attraction is the very tall, narrow window on the east facing wall through which I enjoyed watching the morning sunrise; one of the few pleasures on offer in an otherwise boring room. The large rectangular window on the north facing wall offered a pleasant view of the parkland where, on hot summer days some of the hospital staff gathered to picnic for their lunch (not as fascinating as watching the sunrise). Adjacent to the tall window is a huge television screen that showed  only one channel despite frequent requests to the staff for alternatives. At the time of admission, the given programme every day, all day, was BBC’s transmissions from Rio of the  Olympic games of which I can only remember one exciting event; someone falling of a bicycle. Next to the screen is an equally stultifying display ledge for leaflets, too far for me to reach. On the south wall is a large notice board on which were posted news of my progress such as ‘Donald can now get into bed using the stand-up-walk-round technique. He should not do this without supervision’: not the sort of message to arouse enough excitement to sing a lullaby or two. Next to the noticeboard is a sink and next to that a short gap leading to the exit and the corridor.  On the right of that gap is a very modern en suite. Furniture is pleasantly simple: two armchairs one with wings, (oh how often I wished I could commandeer those wings to escape with.), an ordinary chair and a standard, comfortable hospital bed. I hope this rather mundane description supports my complaint that my immediate environment was uninspiring and unlikely to motivate an active mind for so many hours over twenty weeks  seated in a wheelchair.

PHASE 1

I suppose, though I cannot remember, it was in room 23 that I thought something serious may have happened to me but the business of settling into hospital so unexpectedly was straight- forward enough not to be too alarmed. I could cope with rather simple matters, such as being comfortable, having something to eat, and getting some sleep. I slept well that first night and dreamt that I had won a million pounds on a lottery.  When I woke up I must have tried to get out of bed, no doubt keen to spend the money before the NHS claimed it, but was abruptly stopped by a very loud voice, “Stay in bed! Do not, do not try to get up!” That was my moment of realisation: whatever  I had was serious. So began my long struggle with stroke.

More negativity was to follow, mainly from my body which seemed overnight to have put a restriction on several limbs to hinder their dexterity. This was no dream. I had changed from an ordinary man with my own skills and abilities into one disabled without any obvious cause or reason and no previous  experience of such a dramatic situation. Nor was there any immediate way of knowing what would happen next. When that which had been so certain before no longer was, and without any explanation, then bewilderment is inevitable and I was definitely bewildered. I am reminded of Alice in Wonderland. She fell into an upside-down world where nothing was as she knew it: her height changed several times; she met strange people; and found herself in odd situations like the Mad Hatter’s tea party celebrating unbirthdays.

It is difficult to describe the intensity of the disorientation I experienced. During this phase it is clear from my ward notes that I was someone seeking an identity. I was asking, ”So who is this chap?” Certainly one with problems not faced before; obviously an inexperienced person with faults and disabilities that seriously hampered his ability to get things done such as  opening envelopes; eating spaghetti; playing dominoes; doing up buttons, to name a few and perhaps most disconcertingly, unable to walk. In  my notes, written during the first telling days I was also asking ‘Why?’  ‘Why me?’ The emphasis I put on those two questions was almost morbid but I suspect not uncommon. All the sheets of paper on which  I recorded my feelings,worries, frustration and queries reveal how disjointed my thinking was at that time (q.v, Adenda below) During this phase, while considering who I was, I floated  the idea that I had two distinct parts or roles that might be in dispute: there was, perhaps still is, a ‘me’ that decides on its own physical actions (For example, I have a left hand that is rebellious:(on one unguarded moment it tried to knock me out with a classic uppercut).and an ‘I that makes decisions and commands. These roles frequently conflict. This disjunction is very frustrating for someone who has always been able to get things done without difficulty. It was this loss of control that worried me and made me seek ways of using those things that I could do to regain a sense of being in control of my destiny. Writing seemed ideal: my right hand was unaffected by stroke, my brain eager to be creative despite unsympathetic circumstances and there was little else I could do that would result in a product that I had created.

PHASE 2

Writing worked. At last I was able to make decisions and translate them into action. Furthermore, writing captured  my attention, gave me satisfaction, pleasure and evidence that I had created something for others to share. Early into Phase 2 the contents and presentation were very similar to that in Phase 1: brief statements, some cynical like:

Hang around long enough and the pleasure will soon wear off.

 

Or longer pieces with  their own cynicism:

When I was young I thought the world was made for me.

Now I know it was not- I was meant for the world – to make the numbers up.

So be it. Not my choice but destiny’s.

How destiny makes its choices God only knows.

 

Other snippets were less caustic:

Today I touched the robe of hope

but it was damp with doubt

woven with threads of coarse truth.

hope in life is neatly sown to hide

the patterns that others

sparingly created.

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Once I was a singer                                                      

Now I am a song.     

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Happiness is a noun. 
Misery is a millstone. 
Hope is often disloyal. 
And failure is a reality. 

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But I cannot linger

I must move along.

Who makes these rules?

The despot owner of the fleshpot.

As humans we are ruled by the fleshpot

Who can escape? None.

Apart from more of these tentative poetic pieces, much of my output during this phase was in two styles of  prose. 0ne was commentary on  treatment by which I mean what went on in the ward that was concerned with my well being and reaching the stage when I could be begin to look forward to being discharged. I have edited that material and presented it below under the title ‘Reflections’.The other was essays. I enjoyed setting myself topics to write about. A typical example was ‘Before I Go’.  Earlier in this phase, during a more melancholy mood, I had written my own valediction so something less morbid was a good idea though I doubt that it is original. Uninspired by anything in the room or anything that happened that day I wrote for the sake of writing.

Before You Go

Before you  go’ (or ‘before I go’ as appropriate) is a useful interjection if you have guests who are reluctant to go home or you are  eager to escape at the end of an especially difficult or discordant conversation or discussion. Just when the others thought they had said the irrefutable you strike with,”Before you/I go”followed by any pointless, therefore unexpected, statement as you exit. Of course it is not infallible. Fortunately, a few alternatives are available, again according to context’, for example:

            ‘Good Lord are you still here?’           ‘Look here, if you are going to stay here any longer I am going to charge you for the tea and cakes you have had..

            ‘Do you want me to phone your wife/husband to say  you will be late. Sorry I thought you had  gone.

            ‘Forgive me but if you have anything more to say please put it in writing.

            Holy smoke, are you still here?         I rather liked ‘Holy Smoke’. It had an air of                                                                                                                 mystery and has nothing                                                                                                                             to do with anything.

The next time you come we will arrange for you to stay overnight.

             Before I go I must admit this is an awful essay and I wish I had never started   it.        

PHASE 3

During phase three, my writing became more ambitious. Frustrations and anxieties did not diminish:  In some  ways they increased especially during the negotiations leading up to discharge. The range of subjects and use of poetry also increased: for example I drafted many letters to friends and relatives; I wrote about my observations on a range of issues and practices but I also satisfied a yearning to write more poetry and some fiction. The poetry became more contemplative as though I was trying to find broader and deeper ways of expressing what, at the time, were not simple thoughts and feelings. Humour was not ignored because it is a genre that, as a versifier, I find easier to compose. I cannot comment on the quality but I hope  that what I have done will provide an insight into how I struggled back to being an ‘ordinary man’ again.  A selection from those weeks when escape to home was being negotiated follows.

 Adele One Hair                                                                  At the End of the Tether

This is the tale of   Adele One Hair                                   To the  end of the tether

Who spent his days in a wheelchair                                Is as far as I go

He watched the days come and go                                   Who would leave a dog so

In the hope his hair would grow                                      In all sorts of weather?

Not much luck have I to tell

His plans did not go at all well.                                           Every wished for bone,

Beyond my chain,

Someone suggested he might learn to dance                    Through sun and rain

But of this idea there was no chance                                  In this garden all alone

In a chair he was and in a chair he stayed                        I bark to no avail

However he discovered he could wriggle his toes           I even whine

And now that is as far as he goes                                        From time to time

All he needed was music to play                                         Or wag my tail

And his toes wriggle away                                                   In the hope that

Someone said they looked like Bill and Ben.                    Someone  will  rescue me

 

So what his friends did                                                          Oh that I could become a cat

Was to play Sylvester as he bid                                             Because cats are free.

So his toes wriggled like mad

(Be warned the end of this tale is sad.)

His head remained as bare as a plate                                      Greeting the Day

It shone every evening til late                                            This morning’s orange sky,

But his toes, they grew curls                                               It blazed no trail,

Long ginger curls.                                                                  Was no herald for the day,

Now when round the dancehall he twirls                        Just a beautiful colour.

So do his Shirley Temple curls                                            That is what my life was.

The envy of every dancer there

Whose toes are quite bare.

Now he is called Tip Toes.

Of hairdressers there are those

Who compete to style his hairy feet.

Reflections

This section is a record of those aspects of being in hospital that were to do with my well-being. Throughout my stay I recorded my observations of the work and administration of the ward as well as reflections on the day to day routines and events. Since my discharge I have summarised what I wrote then into simple reports that I had hoped would be presented as appendices the staff could use but the evidence available was slender and I am not qualified to make professional judgements therefore I have to stress that these reflections are my personal comments on my experience. Nevertheless I am qualified as an experienced patient hoping that what I have to say will be of sufficient interest and import for the staff  to refer to  in their professional discussions and deliberations and, where appropriate, in their in-service training. My reason for this hope is based on my belief that the lay person, because of their relevant experience, has a valuable contribution to make towards the improvement of practice.

Environment

Our surroundings play an important part in our well being. Ward 22 is smart, modern and has a fresh, clinical atmosphere. The provision, for each patient,  of a separate room with  en suite, is up to date in hospital design. The environment provided for the patient is very different from the traditional design. In the traditional design several patients share the same ward  and facilities. It is an artificial community with the advantages that come with  opportunities for mutual support and shared interests. The separate room design has the advantage of providing privacy when medical or personal needs require it. Both designs have disadvantages. There are some patients in traditional wards for whom the constant shared life with fellow patients will be too open and they yearn for some privacy. By contrast, the separate room may be too remote because contact with other people tends to be restricted to members of staff mainly in the course of duty and visitors from outside. Neither of these disadvantages should be under played.  Patients’ concept of what is right for their well being includes frequent contact with other human beings.

My own experience of time in hospital  has been in both arrangements. I found the traditional ward, where my cancer was extracted, comforting, secure and reassuring. The care was well tuned to the atmosphere. I suspect that working in a community enables staff to manage greater interaction with all the other members of that community which, by its nature, includes them. These factors, especially being in a community, suited my personality. Can personalities be successfully catered for ?

I found it much more difficult to adjust to the room. Contact with others was largely limited to visits by staff to undertake nursing or caring duties, doctors or visitors from outside such as friends, relatives and officials. The moments of individual, specific care were generally excellent with many benefits but overall the interaction with another person was fragmented. I spent an inordinate number of hours on my own in a wheelchair during my stay which was almost twenty weeks. I found it difficult to adapt to what I felt was isolation, especially as the room, described above, was without inspiration and bred boredom and frustration. However, I accept that this arrangement (i.e. a separate room) would facilitate the provision of privacy for more specific nursing and care should that be needed.

To suggest, as I am, that the environment and its importance should be taken into account in training staff, nurses, carers and others in contact with patients may not seem essential nor practical. Nevertheless ‘environment’ includes those things that we live with: furniture, pictures, ornaments, as well as discarded items that are part of ugly untidiness. One of my irritations was sheets pulled from beds in the morning and left  in a heap in a corner of the room. I would describe that as unsatisfactory. Almost as worrying were the little omissions or extras as when a member of staff, after completing a task that involved moving a patient’s belongings, neglected to return the items to where they were or put them in place out of reach. The latter was particularly frustrating. Many times my bedtime reading was beyond me! My notes record many examples of liitle unfulfilled deeds that would have given me the feeling that I was worth that little extra attention. This minor failure can be easily remedied by establishing a resolution to attend to detail. Those members of staff who knew ‘little things mean a lot’ rarely left me with little to worry about.

On a larger scale, the size and design of space play their part, as does the location of space with specific purposes: are corridors with rooms off a good use of space, especially with regard to the patient and the traffic that caters for them.? As the occupant of the room at the end of the corridor it seemed never to have its fair share of the available traffic passing by and little chance of someone who is passing by to call in to offer a smile or word of interest just when one needed it or was feeling lonely. I gave up counting the number of times people passed my door or stood outside, alone or with others, without saying a word when a cheerful ‘ Hi Donald. O.K?’.would have been uplifting. Even a nod would have sufficed. Most irritating were those occasions when strangers peered in with blank faces; even glances of horror at seeing this old chap floundering in a pool of boredom would have been welcomed  There were one or two moments of uncalled for excitement when unidentified members of the maintenance staff rushed in flaunting coils of cable or   screwdrivers, and on one occasion stepladders. I explained to him that I didn’t need them because I could get into bed  without them. He was not impressed. By way of contrast when any one, nurse, carer, lost visitor or friendly stranger came in sporting  a smile or uttering sympathetic words, such thoughtfulness was precious, especially when getting better seemed to have slowed down or home seemed a particularly long way off.

Not a lot can be done about the building design except by including practising hospital staff at architectural planning meetings – and why not? More thought could be given to décor including displays, their quality, use, and location ( for example they need to be more eye catching and interesting than a montage of leaflets from the NHS) The best use of space, including corridors, also  needs to be considered so that they are not cluttered with equipment or things that nobody knows what to do with. These and similar problems could be dealt with during staff discussions. Perhaps staff could delegated on a rota basis to keep an eye on these matters and comment on them,

Leadership

I have used ‘Leadership’ as the title for this reflection because for me it is the essential quality that determines the effectiveness of every organisation or institution. Having experienced two varieties of hospitals I thought a lot about how they were organised and how that affected me. One variety is the hierarchical arrangement or the top-down management: the other is the delegated or dispersed arrangement  where the organisation or institution comprise several departments or branches each with its own organisation. The categories are my own but I trust they will serve as a useful guide to my comments.

My opinion is that the traditional ward and the separate room arrangements can benefit from the hierarchical system because they both have a high degree of diversity. In the traditional ward that diversity is  many patients in one space to cater for. In the separate rooms ward the diversity is mainly many spaces and much moving  about to take into account. Someone is needed to oversee and weld diversity into a coherent organisation hence the abiding advocacy for matrons. Without an overseer, or with an ineffective overseer, the necessary productive interaction of all the various demands on the organisation are strained and the fabric of efficiency is weakened  If I had a specific worry or problem it was that l found it difficult to decide whom to approach for support or advice. Asking one’s nurse was occasionally unproductive; the response rarely resulted in seeing the person with the necessary authority to provide the requested help or information. Sometimes nothing happened,  These weaknesses had no serious consequences in my case but were annoying. They could be reduced by observing the golden rule of leadership: when in charge make sure the led know exactly what is expected of them and check as frequently as possible to see that they are meeting those expectations. This applies at all levels of responsibility. The intention should be to produce not only coherent and all-embracing strategies to meet the aims of the organisation or institution but knowing what is proving to be effective practice.  This is not about targets,which are for rifle ranges or bench marks which are the result of too much sitting or any other statistically vulnerable measure However it is about knowing, by experience, what is effective and why. Always it has to be recognised such a strategy is very difficult to achieve but lapses easy to detect . During my time, some routines were not consistently followed; for example,washing usually preceded breakfast, sometimes it did not; or one or both did not happen at all; time keeping was poor for some group sessions; there were long delays responding to the ‘buzzer’ call for help (in my conversations with other patients this was the most frequent complaint); follow up to requests did not always materialise; there seemed to be no maximum time for a patient to be on his or  her own; few regular checks were made to ascertain whether I was all right for example.

No doubt many of these observations will be  familiar to the staff and perhaps to visitors but considered rather minor or due to overloaded programmes To a patient, especially a patient recently struck by stroke, inconsistent routines may contribute to unease and concern especially delays for whatever reason. Many weaknesses are undoubtedly due to shortage of staff for what is a very demanding commitment by every member of the staff and a constant worry for the manager.

While I was there in my wheelchair I had the notion that the organisation might be diverse and one or two aspects, such as physiotherapy, were almost independent each with its own overseer. Unfortunately, I was unable to confirm this but I can say I never worked out who was in charge of what. Is that a good thing? The teams seemed to be friendly groups. One critic suggested to me that if staff are too friendly with one another that weakens authority. Does it?

The range and considerable examples of the diversities in the ward occupied a lot of my thinking especially when the teams were changing over just before the night session and again when the night team change over to the day. The teams gathered outside each patients room in turn, presumably to exchange relevant information about the patient’s well-being needs. When I first saw this group outside my room with their notes I thought they were practising carol singers and asked for ‘Away in a manger’ It would be interesting to know how effective each short gathering is and to what extent the patients concerned were consulted and  benefited.

The diversity in a  Stroke ward is very wide. In addition to the challenge of the environment, the diversity of patients is high. They differ by backgrounds, ‘walks of life’,  interests, talents, and personalities; Stroke never hands out the same disabilities evenly to everyone. All of which is obvious, so why did it take me so long to recognise it? Answer: Once I had raised the issue in my mind so the factors  gathered together like a snowball. The magnitude of what the staff in the ward have to cope with, as well as the often changing priorities within that mammoth task slowly became more and more obvious and solutions more and more  difficult to determine. There is a need for a mapping of the territory.

Achieving well-being

Much of a patient’s well-being depends on nurses and carers and that makes them vulnerable to criticism, complaint and perhaps even blame. The attention I received was generally very good to exceptional: That high standard was marred by only one case when I was in pain during the night and buzzed for help. I was asked, “What do you expect me to do about it?”. Overall what was reassuring was the sympathy, often the empathy and understanding that motivated the attention I received. Throughout my time in Room 23 there were many occasions when my spirits were low and one or two when I was very miserable. On every occasion I received comforting wise words from a nurse or carer, words which revived my belief that I could overcome my gloomy view of my future. It is not over dramatic to claim that on one occasion a resignation to tears was changed to a belief in my own capability to cope with  those edges of despair that are the hallmark of Stroke. Interestingly no comparisons were made with worse-off patients. The focus was on my capabilities to overcome my attitude. Very perceptive.

These examples of good practice, are they due to talent or to working alongside good practitioners? Either way, as members of staff they have valuable experience of what constitutes good practice on the ward, especially how well-being is generated. I would trust this expertise to be capitalised. I never managed to establish whether this  level of expertise is represented in decision making. If spreading skilful practice is left to chance encounters between the most skilful and experienced with others who would benefit, that is a waste of special quality resources that should be harvested.

Visitors.

Relatives and friends of the patients are cordially welcomed and visiting hours are generous. These personal contacts with the outside world were more than morale boosters, they punctuated my ward life with opportunities to recover some vestige of feeling that I  was still part of a normal existence. The same can be said of the special volunteer visitors who gave me the chance to discuss so much that was different from the vagaries of Stroke and its wicked ways. I hope this was true for other patients.

The daily visit by the doctors was always welcome and I was very impressed with how quickly they arranged and reported back on any matter which needed attention such as medication, x ray or scan.

Physiotherapy

I have to confess that successful treatment for a stiff neck had been my only encounter with physiotherapy befor stroke so I am not in a position to stick my neck out about its place in dealing with Stroke. I can, however, comment as a patient. My contact was either with a group of patients under tuition with two physiotherapists or as an individual with two therapists. This arrangement worked quite well for me because the group sessions dealt with aspects of disability  such as a weak arm or leg whereas the individual tuition was specific to my perceived needs.

I have used the word tuition but it maybe that ‘instruction’ would be more appropriate.   Whichever it was I would have liked individual tuition more regularly and more frequently because  I believe learning is best advanced with that sort of programme. Furthermore it would enhance learning if the programme was mapped out for patients so that they are aware of the underlying progression and the component parts that make up the development of skills. If that sort of knowledge is available to each individual patient understanding is enhanced.  However the department faces the problems already mentioned above, namely fragmentation of available time.

I was fortunate to attend one or two of the group sessions such as the Wednesday breakfast, the exercise groups for patients and one or two of the groups run by volunteer visitors such as playing dominoes, quizzes and doing a jigsaw. I have no doubt that these groups enhanced well-being. They enabled patients to meet socially and talk about themselves and therefore a chance to ignore stroke for a happy while.  It also made good use of .time when they might otherwise have been confined to their rooms.

Publicity. Ward 22 deserves wider recognition for its achievements and qualities.  If it  had the resources, scribes and finance, a modest, regular newsheet would serve it well and enhance the  mutual support that is already evident.

Postscript

The negotiations for discharge were not straightforward and not without some hard bargaining and sharp disagreement.

Discharge itself was a modest affair- no waving of hands and flags- but a long wait in the discharge lounge: not that I wanted to lounge or linger in the confines of the hospital but patience while waiting was a situation to which I had been conditioned. There was the usual outdated magazines and leaflets to ignore  but I had my discharge document to read. It was dull compared with the magazines and could have been more attractive if it had one or two coloured pictures of me in my wheelchair. Instead it contained various assessments of my capability to cope with the real  world. (For goodness sake I had just spent twenty weeks coping with the world of afterstroke. The real world could not be worse – or could it?) I wonder about the criteria used to assess a patient’s readiness for discharge. I would have liked, as a courtesy, the  opportunity to have seen a copy of this document before I left and to have discussed it with the author as a  recognition of  the significance  of a patient’s participation in their treatment.

So now I am at home glad to be here as a  wistful former occupant of Room 23 at the end of the corridor.   The threatened short story is mapped out and will be written, Fate permitting, but we all know about Fate do we not?

How often doth fate?

How often doth fate bring

Heartbreak to our life

Without warning or reason

The cause of stress and strife

Few pauses in the pains

All costs and no gains?

Ah! sufferer  seek solace,

Accept with grace

The love of friends and saints,

Of kith and kin

With the will to win.

Together you will overcome

For In that haven

Is your future  graven.

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