The 2 Year Life of Brian.

Please, please, please listen. I’ve got one or two things to say.

This is a story about Brian, in the spring of 2020, and how fortunate he was to have all these redeployed physios in the community to help him at his most desperate time of need. It sounded like a military operation. I suppose it was. An about-face from one service to another, to help the most vulnerable during the first lockdown. Among those sent to my team, I had high-ranking sports and spinal specialists. Now they were going to peoples’ houses, making food and emptying commodes.

Trying to master an ‘about turn’ in a time of crisis.

Before we get to Brian, I have to mention how one of those physios came back to the office after a care visit, looking as white as a sheet. He’d been asked to shave the beard of a 93 year old palliative gentleman with a Bic safety razor. With tufts of hair on a couple of large chin warts, they mutually agreed to give those bits a miss. Huge relief.

‘They never warned me about this at uni.’

If it wasn’t for covid, Brian wouldn’t have had the level of input he needed and very much deserved. Rehabilitation comes a distant second to care, and Brian needed both at the same time. Pre-covid, I was the only physio in my community team..

Brian was in his 70s and still working full time. How this event happened, we’ll never know, but he fell down a flight of stairs, resulting in a traumatic brain injury. After a spell in hospital and making good progress with standing practice, Covid-19 rang its bell and initiated chucking out time. Hospitals were no longer a safe haven.

Brian wasn’t able to go home immediately as he needed equipment and a full package of care. There wasn’t enough time to set all this up from the hospital, so he went to a care home to wait. Time told that this haven was most likely even less safe, but that’s where he went.

The care home had no physios, so rehab had ended abruptly. Brian got to the point where he was unable to tolerate sitting out in a chair. So he laid there in bed, staring at the ceiling, day in, day out. His home environment wasn’t going to be big enough to fit the equipment he needed. As well as waiting for a care package, he now needed re-housing. For him and his wife.

Following 6 weeks of nothing, Brian arrived at a bungalow, in a not so pleasant part of the city. It happened to be on my patch, just as all these multi-skilled physios were sent to care for and rehab my community.

Brian had very little feeling down one side of his body, presenting like he’d suffered a dense stroke. He was essentially a dead weight in the bed. Under normal circumstances, he’d have been referred to the community neuro rehab service. But they weren’t operational. So our rag-tag bunch: a specialist generalist (as community physios are known) and highly paid, redeployed experts in shaving old men, were Brian’s only hope. 

We were able to see Brian three times a week, with four of us in attendance each time. Initially sitting him on the edge of his bed. One behind, one on each side, and one in front, to stop him from falling in any direction. Building tolerance so we could start using the hoist to get him from the bed to his chair.

We don’t have the luxury of specialist equipment and loads of space in someone’s house. We improvise and work with what we have in front of us. The brute strength of four physios, and Brian himself, enabled a stand from the edge of the bed. Brian was taller than I’d imagined. Probably the hardest task was stopping his knees from giving way. Two physios using a leg each to block them as we propped him up.

Weeks went by and we were gradually able to reduce the level of assistance. The day finally came whereby Brian was able to maintain his own balance while holding onto a zimmer frame. The next job for Brian was to step a foot forward. To do this meant he’d be standing on one leg during the manoeuvre (sticking with a military theme here). We looked after that standing leg like it was one of our own. He did it. No sweat from him, lots of sweat from us.

Brian eventually walked from the bedroom to the living room with his zimmer and close supervision. He soon did this daily with his carers. He even progressed to using a quad stick and had a wander around his garden. It was just me with him at this point. We’d chat about life. How he'd seen his children grow up and what they'd become. How I saw my 8 year old and my fears of navigating her teens. But Brian was a very calming man, and he reassured me as much as I did him.

In the NHS, we have to draw the line somewhere and discharge. Pass 100% of the responsibility back to the patient. I was sad to do it, but Brian had received a lot of my time, and he had to fly the nest. Would it be right to say that the pandemic had dealt him a huge slice of luck? It would be right to say that we physios are bloody brilliant at what we do.

Given the chance and the resources, the difference we could make to peoples’ lives would be off the scale. I bang on about improving the quality of life of those around us who suffer with injury and illness. When the redeployed returned to their actual jobs, I was on my own again. It’s just not right.

Imagine if I got through these ten patients in a day. Then imagine if there were four physios. That’s 40 people a day receiving rehab in my community.

There’s an article from the Chartered Society of Physiotherapy, discussing how rehab spaces have reduced since Covid. This has affected staff morale, stress-levels, and job satisfaction. Physios are considering leaving the profession due to being unable to carry out work to the best of their abilities.

‘It is every bit as vital as surgery and medication, but you wouldn’t ask a surgeon to operate without a theatre.’

‘We must see immediate action to improve the working lives of our members and ensure patients receive the quality of care they deserve.’

A year ago, I was off-duty and visiting a friend of mine in the hospital. My friend joked that the bloke opposite him, although sweet, was dropping the most horrendous farts that could clear any room. If he could’ve escaped, he would’ve done. I looked over. It was Brian. I knew how tall he was, but he looked tiny in that bed. So frail and helpless. I wanted to go over and apologise. Pangs of guilt. Knowing full well that he’d never receive the same level of input again, and it would break my heart. And maybe his.

I visited my friend the following week. Brian was no longer in the opposite bed. My thoughts ran away with me. So I had to bring myself back to Brian’s one and only wish from physio from 2020, after suffering that horrendous brain injury. I’ve not mentioned it yet, but it was the force that drove his rehab. Thankfully and blessedly, he did get to walk his daughter down the aisle.