Healing time

Many of us remember convalescent homes in the Fifties and Sixties tucked away on the leafy outskirts of towns, in the mountains, or by the sea. Papworth Hall, where the Royal Papworth Hospital – the UK’s leading heart and lung hospital – once resided, was originally set up to provide aftercare for the thousands suffering TB in the wake of the First World War. These havens of healing go back to Florence Nightingale, who in 1859 recommended convalescence cottages in the country or by the sea. The rich, meanwhile, took to sanatoria or spas abroad, some of which still survive, offering what’s been called ‘medically informed repose… far away from the world’.

However, the days when convalescence was considered a vital part of recovery are long gone. Now there’s a pressure – real or imagined, internal or external – to step back into everyday life as fast as possible. ‘We used to be much better at convalescence because in the past, medicine was less powerful and the best aids to recovery were rest, healthy food, gentle activity, hygiene and fresh air,’ says GP and author Dr Gavin Francis. ‘Even in my home city, Edinburgh, there were several convalescent hospitals. There’s no modern equivalent, so people are either in a busy acute hospital ward or they’re expected to manage at home. There’s nothing in between.’

To be clear, Dr Francis would not be without 21st-century drugs, blood tests, scans, robotic surgery and other medical advances. And he acknowledges that recent NHS programmes which encourage patients to get fit before an op, and up and about as soon as possible afterwards, have improved recovery times immensely. But what convalescent homes provided was a bridge between being ill and being better, a kind of ‘magic’ mix of time, rest, good food, company, fresh air and – with a doctor looking in once a day – that crucial feeling of being looked after. It’s not always easy to replicate that at home, but Dr Francis believes there are lessons we can take from it.

‘A windowless box with the sound of machines beeping is not exactly conducive to recovery’

However, he isn’t advocating prolonged bed rest, once the mainstay of convalescence. That can make things worse, especially as we get older. Lying around for too long, he says, ‘melts muscle from bone and withers the connections that sustain us socially’ and can lead to a spiral of loneliness, disability, and loss of independence.

In fact, convalescence isn’t a passive process; we need to engage actively with the process of healing. The most important ingredient is time, and setting yourself small, incremental goals. ‘Recognise you’re not going to get better overnight and set easy, achievable goals that you can build on,’ he says. ‘If you’ve just had a hip replacement this might be, “I’m going to walk to the toilet without a walking frame.” If you’re experiencing muscle pain after major abdominal surgery, it may be, “I’m going to walk round the garden slowly.” It’s also vital to view yourself kindly. Treat yourself with compassion and recognise you’ve been through an ordeal.’

The importance of a healing environment – somewhere spacious, calm, light and preferably green – can’t be underestimated. ‘There’s good evidence that people in hospital who have a window that opens and looks over somewhere green need fewer painkillers,’ says Dr Francis. ‘There’s even a suggestion they might be able to get out of hospital faster. If you’re in a windowless box with the sound of machines beeping it’s not exactly conducive to recovery.’

Professor Derick Wade, consultant in neurological rehabilitation and visiting professor at Oxford Brookes University, believes that convalescence serves an important role in our minds: to bridge the road between sickness and health. But if your day is punctuated by doctors’ appointments, tests, and procedures it can be easy to get stuck in passive patient mode, which may make us feel safe but is ultimately limiting. Telling yourself you’re in convalescence mode can help usher you back to a new normal.

‘Adopting a “sick role” for a time made sense in the past when illnesses were mainly short-term and due to acute infections or trauma, and people either got better or died,’ says Professor Wade, whose website Rehabilitation Matters is dedicated to rehabilitation and recovery. ‘But, it’s less relevant – and can be positively harmful to mental wellbeing – these days when many of us are living with chronic or long-term illness.’

And at a time when Covid-19 and its evil twin Long Covid have presented us with a disease more akin to TB – for which time, rest, sunlight, wholesome food, and fresh air were the only treatments – convalescence should be ripe for a comeback. However, it is massively underfunded in the UK, which spends 10% less than any other European country and is abysmally short of trained specialists. And with all the pressures faced by the NHS, a return to convalescent homes seems unlikely any time soon.

But there are plenty of things we can do to help ourselves heal, as Dr Francis points out: spending time with family and friends, walking, dancing, singing, travelling if you can, or if you can’t, doing so vicariously through the stories of others or books, or simply sitting in the sun with a beloved cat or dog on your lap or by your side can be wonderfully therapeutic.

10 steps to recovery

1 Distance yourself from patient mode by changing out of your pyjamas into ‘proper’ clothes.

2 Get outside. Studies suggest ecotherapy (being in nature) boosts health and wellbeing.

3 Eat well. Protein is important for recovery from any illness and is vital post-op: think fish, meat, cheese, eggs, and pulses. Go for small, colourful meals if you don’t have much appetite.

4 Learn to tune into your body but try not to get obsessed by every little ache and pain.

5 Set yourself small incremental goals and reward yourself when you achieve them. 6 Expect ups and downs. Recovery rarely takes a straight upward trajectory so bear with the bad days and celebrate the good ones.

7 Plot your recovery in a diary. This will enable you to see progress despite setbacks.

8 See friends and family. This can help lift mood. Keep visits short and sweet at first.

9 Find a new purpose. Once you begin to feel a little better think about things you really want to do, such as new activities or trips.

10 Keep hope alive. As Dr Gavin Francis writes, ‘Though we often can’t overcome illness, we can find ways to improve our circumstances and live with it in a sort of negotiated peace.’

READ… Recovery: The Lost Art of Convalescence Dr Gavin Francis (Wellcome Collection)

VISIT… rehabilitationmatters.com Professor Derick Wade’s website on all things rehabilitation

LISTEN… bbc.co.uk/sounds/play/m0015lqk The BBC’s Inside Health on the power of convalescence