FORTALECIMIENTO INSTITUCIONAL

Whilst undertaking the analytical coding it became abundantly clear that the milestone that carried the most significance for patients during the in-hospital phase of recovery was that of leaving hospital. Whilst most displayed a positive, almost

desperate desire to return home, others conveyed a mixed picture of positive expectancy whilst harbouring anxieties and fears when faced with the reality of imminently leaving the hospital. A few were contemplating the homeward journey reluctantly and one appeared completely indifferent to the prospect.

Mike, a seventy-one year old who had collapsed in cardiac arrest in the hospital car park after being discharged home, stated brightly that he had no worries or fears about returning home because he considered that he was now ready to return home. He had made that judgment and was able to articulate why this was important to him, but his judgment was not made in the context of a return to health, but because of his need for good quality rest and sleep away from the considerable distractions that accompany modern in hospital care.

KS: mmm, have you got any worries about going home? Mike: no worries at all

KS: are you looking forward to it?

Mike: I am, I...I would go now if I could (laughs)

Mike: because you can't err...these places...you cannot really rest, you can't sleep, you know, there's something...your...your brain goes to mush all the time. You listen to other people moaning and groaning and…and just when you're settling down, somebody comes along and 'hello, excuse me, Michael'' and they want to give you this, I want you to take this...I want to...you know

However, in the interests of ensuring his timely departure from the hospital, Mike indicated that he intended to be fully compliant with the recommendations and guidance offered to him by the medical gaze.

“All I’ve got to do is follow the rule book properly and do what I’m told”.

When directly questioned, Graham was absolutely clear and very positive about his imminent discharge.

KS: It's erm...what would...what's...what are your biggest worries about going home?

Graham: none

KS: haven't got any?

Graham: No…just want to be there...

Even when questioned further about how he had planned to occupy his time, Graham has already formulated his approach, where he anticipated that he would receive advice and guidance from the doctors as to how best assist his on-going recovery.

KS: Have you got any ideas about what you're going to do with yourself? Graham: well yeah, I mean, take it easy for a while but...

Graham: No, I think that is something the doctor will tell me before I go, I mean he...he's not going to say anything now...but he will obviously tell me

tomorrow...that yes I can go home err...I think he said that there, that you know, they'll obviously let me know what the situation would be...

Janet, who was recovering from aortic valve surgery, had a different perspective had indicated some frustrations with still being in hospital more thirty-five days after her surgical procedure and cardiac arrest. She was anxious to return home and in the following extract from the interview transcription, Janet made a further reference to her mobility.

[…] every morning I wake up in that bed...I'm...my first few steps are quite shaky...which is annoying me.

Janet’s dry, sarcastic tone seemed to purvey a covert sense of bitterness and regret about her situation and her decision to agree to undergo the procedure, which in itself raises a number of other questions. She appeared very keen to avoid any form of medical surveillance, which is a separate recovery theme, visited in detail in chapter six. Janet had retained significant concerns regarding her mobility and when contemplating her suitability for discharge she was clear about her needs. Sensing the pressure from the healthcare team, she was adamant that everything should be in place before her imminent departure from the hospital.

[…] 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.

However, Janet did occasionally express positive views about her future and one that was particularly interesting occurred when she went to reveal a more longer-term recovery milestone. She hoped that she would at some point during a period of

convalescence, be able to spend some quality time with her husband, at their caravan.

[…] erm...I've lost most of this year...we've got a caravan down on the south coast...I would dearly love to get down there...even for a few days.

Some patients were more reticent and apprehensive than others, depending on their own specific set of circumstances and their expectations of their continuing recovery. Alice was a ninety-two year old lady who had suffered a myocardial infarction followed by a cardiac arrest that had occurred during coronary angiography in the cardiac catheter laboratory. Her recovery was medically uneventful and during her interview she displayed a rather laissez-faire demeanour and appeared indifferent towards her recovery progress. Alice lives in a warden controlled flat within an elderly persons community and has a cleaner that visits her daily, she did however maintain that she was functionally independent. Alice was a participant that used very few words to convey her experiences and gave very little away. Nevertheless, it was clear that she was not particularly looking forward to going home, but not unduly worried or anxious and summed up her impending discharge when she said she will "just go and cope".

Eddie was able to readily express his particular concerns regarding his rather eventful recovery from two cardiac arrests, which had followed the coronary artery bypass graft surgery he had undergone. He wanted to be absolutely certain that he was in the best possible condition prior to leaving the hospital and he had almost reached that point at the time of the interview. Eddie was discharged home three days after the interview had been conducted.

KS: Have you got any particular concerns, worries, anxieties about...going back home?

Eddie: Erm…yes that's why, at the moment, I am in no tearing rush to get out of the hospital until I assured that I'm a hundred per cent, because I still have this fear in the back of my mind, I still don't feel a hundred per cent well at the moment, a couple of days after the episode and I'm putting that down to the concoction of drugs and that were pumped into me...erm...but...but I do feel confident and happy now that the problem appears to have been identified, rectified and erm...one can only go forward, so yeah.

David, who had his cardiac arrest at an underground station and sustained a minor brain injury as a consequence of falling as he collapsed, took a very broad, pragmatic and almost matter-of-fact line towards his recovery progress.

KS: What do you expect to happen to you in the next few days and weeks? David: Well I expect to have a bit of surgery, heart surgery erm...I expect to recover, I expect to go back to work erm...I...I expect erm...a bit of a slow pace leading up to Christmas and perhaps after Christmas maybe it will pick up a bit faster?

David was very much looking forward to getting home, largely it would seem, to enjoy a more restful, comfortable sleep, a point that had also been made earlier by Mike.

KS: see how it goes? And what's erm...what are your thoughts about going home? DJ: I'd love to go home, simply because I just can't sleep at night here...it really is just...I don't know what it is about the place, and I'm...I'd like to go home and have a good nights sleep and I was hoping that was going to happen like tomorrow, but that's not going to happen.

Gordon had other worries about his return home and these were centred around the situation with his wife and the impact that their decisions about her discontinuing work status were likely to have on their financial status.

KS: how do you...have...what worries have you got about, if any, about going home?

Gordon: I haven't got any worries at all... KS: none at all?

Gordon: None at all...oh, I've got a slight worry about how I'm am going to finance all this...

GD: Finance all this, because... KS: Finance it?

GD: Finance in a sense that...my wife has just given up her job... KS: mmm

GD: so, we've got to think about doing something else to fill the gap, you know...

There were only two patients that directly referred to the negative impact that their recovery from illness might have upon their financial situation, the other was Graham who referred to an on-going situation that pre-dated his current illness and had been receiving telephone calls from his bank during the acute phase of his recovery.