Dr Nick Read

The dangers of going to bed.

It had been a long night.  Although my hospital bed allowed me to adjust my position,  the slightest movement of my back was agony, and I could not get comfortable.    The plastic mattress was damp with sweat and my pyjama top was rucked up my back and impossible to adjust.  I was terrified of coughing and avoided drinking so I didn’t have to go to the loo.  Sleep was impossible.  Kyle, opposite babbled incessantly in his sleep and Arthur’s laxatives worked their poison noisily on him throughout the hours of darkness.  My sole consolation was the morphine; the spreading warmth of the injection, the distancing of pain, near oblivion with just a residue of hope.  I think I would go into hospital just for the morphine. 

The day started well.  I sat out in the chair for breakfast, but when Beckie, the staff nurse, she of the sidelong glance and provocative eyes, asked if I wanted to have a shower,  I could have kissed her.  Getting to the shower was painful but not impossible, but the luxury of hot water was nothing short of bliss.  I ripped all the ECG tabs off and soaped myself all over.  I even managed a bit of a bowel action and I collected the urine sample, Beckie, wanted – though it more resembled a glass of pink grapefruit.   

It was the sample that did it.  Haematuria ++++!  Bugger!  Beckie was back in a few minutes, eyes raised, smiling.  ’The doctors want you to have a scan of your abdomen’ and she added with a note of triumph,  ‘It’s strict bed rest for you!’ 

The scan showed I had fractures of 3 lower right ribs, fractures of the transverse processes of some of the vertebrae and collections of blood above the liver and around the kidney.  I must have had quite a biff.  It’s probably a mercy I have no recollection of the event.

The edict was reinforced.  I felt like a man who had been let out of prison only to be recaptured a few hours later.  I had already been walking about.  I was moving, feeling better with each step, my urine was as clear as a mountain spring. This restriction seemed very negative. 

I rebelled.  I sneaked to the loo when Becky wasn’t looking, but she always caught me.  But in the end, I submitted.  I was a doctor.  If I couldn’t obey the rules in hospital, then who could?  And I didn’t want to get Beckie into trouble.     

Bed is the most dangerous place if you don’t need to be there, particularly a hospital bed.  The body needs to be active to recover.  Lying in bed does not encourage you to breathe deeply.  Secretions can collect and stagnate at the bases of the lungs.  Stagnation encourages infection and hospitals are breeding grounds for the strangest and most resistant of infections.  Coughing is often painful and non-productive.  The worse complication of being in hospital is a chest infection. 

The second is probably a urine infection. It is difficult to pass urine while lying in bed. People don’t drink enough and hold on.  Stagnation of urine can allow it to become infected, especially in women who are especially to infection rising from the perineum through a short urethra.

Another torment of bed rest is constipation.  Using a bed pan to pass faeces is an acrobatic feat.  Sore muscles and ribs make it impossible to strain.  The result; your waste just sits there, producing noxious gases, irritating the rectum with its presence, infecting your mind.  There are few ailments as depressing and frustrating as constipation. 

If bed rest is prolonged for more than a few days, it is accompanied by other perils, such as muscle wasting, loss of bone, impairment of appetite and depression.

Broken arms and legs can be protected in plaster or pinned or plated, but fractured ribs and vertebral processes must be allowed to heal up by themselves, surrounded by their splint of inflammation and muscle spasm. Muscles that are not used, waste with great rapidity and no longer protect damaged bones. 

Bones lose calcium if not used,  becoming weak and brittle, and leaching calcium which can deposit in the kidneys as stones. 

The appetite suffers when we are not active.  Hospital food often doesn’t help.  And with loss of appetite and mobility as well as the companionship of friends and family, we get depressed, losing energy and drive and the essential will to get well.    

Bed rest is essential if you have an infection or a heart attack or a flare up of colitis or rheumatoid arthritis, you just don’t feel like doing anything else.  You have no energy and no choice.  It is the effect of infection and tissue damage.  But if you have had none of these things, then enforced bed rest is one of the greatest perils of being in hospital.  So if your body tells you it’s ok and there is no obvious risk of movement, get up as soon as you can, keep moving, exercise, stretch.  Listen to your body.  Believe me; it will save your life.

I am slightly, but only slightly, ashamed to admit that I ignored the edict and as soon as seemed polite and feasible (that same evening!) took my own discharge.  They do say that doctors make the worst patients in that they won’t always do as they’re told, but I sometimes think that their insight gives them the opportunity to get better more quickly.  

It is just six days after the accident and I have completed an inspirational run – well an old man’s soft shoe shuffle – down Dove Dale and back.  I feel tired, sore, but I’m healing up.