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February 11, 2011 10:00 pm
Once upon a time, illnesses and accidents led to obligatory time in bed. Indeed, this is where your doctor would most probably see you – you would not put your coat on over your pyjamas and go and sit in a waiting room watching videos about swine flu until your name was called. For most of the last century, bed rest was the recognised medical treatment for many things – hysteria, high blood pressure, heart failure. Poor lungs or a bad back could get you laid up for weeks. Proust spent years of his life in bed, nursing his asthma in a cork-lined room. Robert Louis Stevenson spent most of his childhood bedbound with tuberculosis; George Orwell much of his adult life.
But it is now very difficult to take to your bed – even in hospital, which is full of beds. We prefer people to get out of them. We like people to “sit out” or, better still – as some people sit out in such a horizontal fashion that they may as well be sitting in – to “mobilise”, which is the medical terminology for “taking a walk round the ward”. Staying in bed has been shown to be bad for you, on the whole. Lying flat is unhelpful for your lungs – secretions gather at the bases and are hard to clear, increasing your chances of developing hospital-acquired pneumonia (a more unpleasant disease than community-acquired pneumonia, because the germs that colonise hospitals tend to be more resistant to antibiotics). Prolonged immobility contributes to venous stasis – the blood pooling in the veins – which increases your chance of developing a pulmonary embolism or a deep vein thrombosis. And – as anyone who has tried it will know – it is difficult to empty your bladder completely when urinating into a bedpan or bottle, which puts you at greater risk of developing a urinary tract infection.
Less obviously, your perspective, your expectations and your mood can all change, making it difficult to return to being upright in the outside world. When the heroine of Susan Coolidge’s What Katy Did fell out of a swing, she spent an entire children’s novel in bed, learning how to be ladylike in what her invalid (and extremely preachy) cousin Helen calls “The School of Pain”. But prolonged periods in bed are not kind to most people’s psychology. Elderly patients become depressed; depressed patients get worse; young patients suffer from intense frustration. One of the last groups of patients for whom bedrest is still routinely prescribed is women with complications in pregnancy, such as a threatened premature labour. I have never heard the experience described as pleasurable. Three days may be desirable; three months is unbearable.
But that doesn’t mean it feels right to get out of bed. Once upon a time, when you hurt your back, your GP would tell you to go home and rest. Now they want you to try to spend as little time in bed as possible (for simple bad backs, bed rest is thought to complicate the muscular injury by preventing movement, causing worsening stiffness and, in the longer run, more pain).
So you have a situation where your body appears to want one thing and your doctor wants another, which is not, unfortunately, uncommon in medicine. I once heard an elderly lady crying out from a side room. I found she had fallen into her bed; she was lying across it in an awkward diagonal. She wanted to be straightened out, and tucked in. At 11 o’ clock in the morning, it was medically incorrect to do so, but humanly difficult not to.
Sophie Harrison is a hospital doctor in South Yorkshire.
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