The British royal family has had to face some health issues of late. King Charles was briefly admitted to hospital for a procedure to deal with benign prostatic disease.
Within a week came the news that he had been diagnosed with cancer, site unspecified, with the treatment regimen requiring him to withdraw from public engagements for some weeks. And just prior to that, Kate, Princess of Wales, entered the London Clinic for abdominal surgery, which we were told would require a two-week hospital admission.
The princess decided not to share the reason for the abdominal surgery, which in the end required a 12-day stay in hospital. While there was some speculation online about her diagnosis, the issue of interest for me was, why the long hospital stay?
We are now in an era of medicine where hospital stays for a wide range of surgical interventions have been shortened dramatically. For keyhole abdominal surgery, for example, a two-night stay in hospital is sufficient in most cases. Some older people, undergoing hip replacement surgery, are visibly shocked when you tell them they will be out of hospital after three days. The emphasis now is on early mobilisation of the new hip and a relatively early discharge.
So, the Princess of Wales’s length of stay is a significant outlier. The question is: why? My speculative answer is that it may have been a deliberate decision on her part to allow for time to convalesce.
Convalescence is the gradual return to health after illness or injury – a gentle process of recovery. Once an established part of medical care, by and large it has now become an outdated and lost art. Back then, the healing process was regarded as gradual – a patient would typically move on from a place of high care after a medical intervention to a place of convalescence where you could be supported and cared for.
Scottish GP Dr Gavin Francis has written a thoughtful book, Recovery: The Lost Art of Convalescence (Wellcome Collection). Recovery, he says, is a separate therapeutic process that deserves attention – the recognition that it takes time to rebuild ourselves, that not everything can be solved instantly with a pill or a high-tech procedure. Illness, he writes, “is not simply a matter of biology, but one of psychology and sociology”.
He argues that failing to set aside time to recover can seriously undermine our ability to return to good health. We now treat convalescence less as a chance to heal than as something to get over with quickly.
In an online Medscape discussion about his book just before Christmas, Francis’s explanation of his response to long Covid was instructive: because the condition is so poorly understood, he is unable to fall back on a biomedical reassurance of telling patients exactly what’s going on. What he can do is share with them what has helped others: “I can tell them stories of other patients. I can tell them stories about recovery from other kinds of chronic fatigue or chronic breathlessness.
“Rather than seeing ourselves sitting opposite the patient, shrugging and saying, ‘Sorry, we don’t understand this condition, I’ve got nothing to give’, instead we can come around the desk, sit beside the patient, and say, ‘Let’s go on this journey together. I’ll tell you what some other people have told me’.”
This sounds like a perfect opening for convalescence to begin. Take your time, go forward slowly, explore some side avenues as your journey progresses. Perhaps most of all, allow your head the space to deal with any life changes your illness has brought about. Clearly, any resurgence of convalescence also requires doctors to re-engage with the lost art.
Obviously, I cannot prove that Princess Kate’s prolonged hospital stay was to enable her to convalesce. But if it facilitates a renewed focus on the art of convalescence by doctors and patients, her story will have done us all some service.