Capacitación, Calificación y certificación:

In chapter five, there were patients who were keen to escape the attention of the clinical gaze and were not unduly perturbed when considering their return home to the embrace of the gaze of their host community. There were others who clearly expressed anxieties and fears about their potential vulnerability consequential to their disease and a perceived risk of having a further cardiac arrest.

There was one patient who portrayed an almost complete belief in the safety of the extended clinical gaze. Sanjay was interviewed the day after his cardiac arrest and during his interview his general demeanour and emotional status indicated that he was overwhelmed to have survived the event. Unsurprisingly he was positive about the medical work that had been conducted on his body from the moment that which he collapsed at his yoga class, right up to the present point within the interview. Even though the gaze was investigating a potential technological failure with his pacemaker, he clearly placed considerable faith in the work of the medical gaze and its availability to him at his point of need.

[…] well look, I...I have to trust the doctors because they...they know...they know what's happening to me better than anyone else and erm...you have...you

have...you have to...I think you have to have some sort of trust...that level of trust and you have to...I understand that they...they...they're here for you, but having said that I can still do what I want once it's in there, couple of months, three months, I can go back to normal […]

It was interesting to note the nature of the language that both Eddie and Janet had used when they were thinking about leaving the hospital. Janet, who expressed a very negative view towards the interference elements of the gaze, verbalised that she had felt like the ‘Prisoner of Zenda’ at times during her hospital stay, whereas Eddie, despite having demonstrated a largely positive view of the hospital gaze, also referred to a captivity status about his admission to hospital.

[…] after, I believe it was three-days, the staff here were sufficiently impressed or pleased with my progress that they were talking about releasing me within a day or two, and that I actually achieved...they agreed to release me on the...I forgive the dates...erm...Sunday...Sunday's date?

With regards to his readiness to leave the hospital and determine his own recovery pathway, Frances depicts a regulatory conflict between his intentions and those of the clinical gaze. Here Frances appears to reject the gaze and assert himself as a more effective agent in the regulation of his recovery and the important decisions about when he is ready to leave the hospital.

Frances: and I don't see what the hell it's got to do with them, as to whether it takes me three weeks to get there or whether it takes me two months - I will get there.

KS: You are determined about that are you? Frances: Yeah, yeah.

KS: Do you consider saying to folks, you know, the interventional folks...I need to do this in my own time?

Frances: Do I?

KS: Do you...does it ever occur to you to say to them... Frances: yeah, but you offend them.

KS: Well, do you?

Frances: Well, I know...I couldn't care less...I'm afraid.

Whilst demonstrating her disquiet with the manner in which her discharge planning had been handled, Janet took a similar contradictory position to that of the gaze when

discussing her impending discharge from the hospital. She seemed to be mindful of the continuing overt regulatory presence of the clinical gaze, a gaze that did not appear to her involve her at any point in the decision making process.

[…] and for them to then say that I can't go home...erm, and if I do so I will have to remain in my bedroom, which is, is about the size of this room, until they approve the house to their satisfaction. Ah, either that or I stay here indefinitely...until they all got together and had a bit of a conflab […]

Janet continued to elaborate on her position and displayed some distress at having been kept out of the picture, appearing powerless in the discussions as different elements of the hospital gaze attempted to determine what was best for Janet, whereas she had considerable belief in the abilities of her husband to provide the necessary support. During this part of the interview Janet appeared desperate to escape from the clutches of the hospital gaze, but as is seen in the second quotation from a few minutes later in the interview, she was also anxious about being visited in her home by agents of the gaze.

Janet: you know...erm, I was sitting here crying my eyes out this morning...having changed it all again.

KS: right...

Janet: ...ah...and the nurses started trying to get hold of somebody during the day to see if they could...push things forward, but I can't go home until there's a

complete care package for (inaudible) KS: mmm

Janet: ...that care package, is fifty-three...has been married to me for fifty-three years, he knows to cook...

[…] but err...I am sorry I've got to get back to this...got people banging on the door and wanting to come in...see how old your carpets are...I mean...I...I feel it's a total intrusion [...]

Stephen was less confident in his ability to regulate his own health seeking behaviours and was more comfortable with the expertise offered by the medical gaze. He had expressed anxieties about collapsing again, particularly in comparatively remote locations, such as a park (see chapter 4, section 4.2, page 91). His concerns were about being out of the surveillance range of the clinical gaze. However, Stephen was not entirely happy with the extended gaze and was puzzled at the insistence of the long arm of the hospital gaze that he attended a particular cardiac rehabilitation programme associated with the hospital where he was recovering, rather than one that was much more convenient for his personal situation.

[…] So its it...I don't have to walk that far, its much further to walk to King's Heath, but that...that's just purely convenience really, more than anything else

erm...and...err...the first...there was a young girl came in with all the leaflets about this action group thing and she said 'I'm from St Jude's' she said 'I'm...you should come to St Jude's this, 'cos this is really good' and she said 'in fact I could sign you up for it now if you agree', and I...I thought well...no, no, 'cos I don't...I don't know mmm...this has just been put on me and I don't know...I haven't taken

any...anything into account...

The hospital gaze appeared to have subtly pressurised Stephen into their particular rehabilitation programme, but as he indicated, the agents of the gaze did not give him sufficient time to think about the information that he had been provided. However, it did seem likely that he would comply with the request of the gaze and attend the cardiac rehabilitation clinic as directed.

Based upon his brother’s experiences of the cardiac rehabilitation programme, Eddie appeared somewhat sceptical about the value of attending when he was being told about the necessity of his forthcoming surgery by his consultant.

[…] explaining what happens after, setting up, telling me about the programme, giving me lots and lots of information and I've got to say been very helpful, very useful...I would say at the time, I wasn't too interested, I was too upset at having the procedure coming up that I really wasn't of the mind that I wanted to read and take it all in at that time […]

[…] I've got a younger brother that had an almost identical operation eighteen months ago and he had spoken to me about the rehab and he was very cynical of it...erm...however, he did say, you know, the road to recovery is a change of lifestyle, you know, change of diet...change of...excuse me...bit of a change of attitude as well, and he said, by the time you get as far as their clinics they're a bit like, you know, a bit patronising and zumba-like, err...so I'll wait and see, I'll keep an open-mind, but yes I have had offers of help on that and I'll certainly take them up, yeah no problem. The two people that I actually met in the hospital were very helpful […]

Eddie’s impressions of the extended clinical gaze in the form of the cardiac rehabilitation workshop suggested that the timing of the information about his

postoperative recovery was not helpful to him as he contemplated undergoing heart surgery. Despite his brother’s views and his misgivings about the information provided, Eddie indicated that he would attend the cardiac rehabilitation programme and comply with the overtures of the gaze.

In the research design, it was intended to explore the concept of a follow up clinic with patients recovering from cardiac arrest, which of course represented another extended arm of the clinical gaze, the following extract of the transcript from interview with Eddie was typical of the responses that patients elucidated.

KS: to find out what you...what...what patient's views are...and if erm...you've spoken to me today for quite a bit of time...would you like...do you think when you do go home...an you, you know, you start to normalise, do you anticipate that you might want to speak to an expert, someone like me, at some point about what's happened to you?

Eddie: no, not really... KS: really?

Eddie: No. I'd...rather...I'd rather clearly put it in the past if I felt that I'd made a full recovery.

Sanjay, who laid his position out very clearly in his response to being questioned about attending a cardiac arrest follow up clinic, echoed Eddie’s position almost identically.

SM: now, because...because when I leave the hospital I'm fine, I wanna forget everything and I wanna go back to my normal life.

Stephen was able to recognise the potential benefits of the follow-up clinic, but remained non-committal suggesting reluctance in participating in further activities associated with the extended clinical gaze.

[…] you know, if you are...I think it's good to have follow-up things where people can sort of, 'how you getting on', blah, blah...this, you know and make you think of other things that you may need or how you're coping with it […]

By way of a complete contrast, at the time of their interviews, David and Colin both responded with a straight “no” when asked if they had been approached about enrolling onto a cardiac rehabilitation programme. None of the patients who were asked for their opinion as to whether they were likely to attend a post-cardiac arrest support clinic answered with a firm positive.