Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care. The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting. The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com
I read Roald Dahl’s ‘George’s Marvelous Medicine’ to my children today and my son said, “You really love the Grandma in this don’t you Mum?”
It’s true! It was one of my favourite books during my own childhood and I now spend a large amount of time perfecting the Grandma’s voice for my children and absorbing the story with them as they snuggle on the sofa. There is personal meaning to some of the pictures too and so a picture of George stirring the giant saucepan is hung on our kitchen wall. The text describes ‘A rich blue smoke, the colour of peacocks’, at which point we cheer because Peacock is our family name.
Re-reading this book to my children has made me wonder if it formed the foundation of my understanding of Geriatric Medicine and to even explain how I inadvertently found myself working in Community Geriatrics providing home visits. This link is surprising really, because the book opens with a warning to readers: ‘Do not try to make George’s Marvellous Medicine yourselves at home. It could be dangerous.’ I had initially thought that this book revealed a dislike for Medicine but I have recently delved into Roald Dahl’s biography and learnt that he worked in partnership with an engineer and neurosurgeon to develop the Wade-Dahl-Till valve, used to maintain the patency of cerebral shunts.
Most importantly the book opens with an acknowledgement of the difficulties faced by carers, as George’s mother rushes out to the supermarket and George describes how, “Looking after her all by himself was hardly the most exciting way to spend a Saturday morning.” A large portion of any home visit I do entails identifying when carers need additional support, without looking after them any plan put in place to avoid unnecessary hospital admission will always fail.
It is always the picture of George’s grandma sitting in a chair that remains my reference point for the definition of frailty, a term mentioned in any NHS gathering with increasing frequency. Grandma sits in her favourite chair, hunched over a cup of tea with skinny legs placed on a stool. She displays the frailty phenotype and despite the sugar placed in her tea by George, she is described as being thin and does not have the energy to go and make this beverage herself. It is later confirmed that Grandma also has low physical levels and exhaustion when she describes that she has not left the house for twenty years. George acknowledges how difficult this frailty syndrome will be to reverse when he declares, “I’ll make her a magic medicine, a medicine no doctor in the world has ever made before.”
George moves around the house performing a Comprehensive Geriatric Assessment by collecting the various ingredients for his medicine and carefully considering the need for each ingredient. He declares that the addition of grease will, “grease her creaking joints’ and considers everything from her oral health to her mood. This frantic collection remains the best explanation for an effective medicine review I have ever found, George stops the medicine that Grandma has daily because it has no positive effect and puts ingredients into the new medicine if he can justify their addition. I admit that the addition of some of the ingredients are just because he enjoys the squirting of aerosols, but perhaps even in this frivolous action Roald Dahl is reminding doctors that we need to experience the joys within our job (they are there).
After taking the medicine, temporarily catching fire and then growing quickly towards the roof, Grandma declares that it is: “Terrific medicine!” I suspect it is the freedom and re-establishment of independence that leads to the repeated shouts of “owwweeeeee!” Although Grandma regains mobility quickly, the physical changes occurring with age do not leave her. Roald Dahl even provides a description of sarcopenia when he explains that, “there was a difference between the way the hen was growing and the way Grandma grew. When Grandma grew taller and taller, she got thinner and thinner. The hen didn’t. It stayed nice and plump all along.” Grandma’s continued independence is guaranteed because the correct mobility aid in the form of a galloping pony is obtained for her and with this newly found freedom requests for tea and cake multiply.
This book is a cornucopia of Geriatric Medicine and at its heart is the importance of regaining functional independence. The challenge of improving mood, autonomy and physical ability is what continues to attract me to Community Geriatrics and to stories that champion these ideals. I have been asked to providing teaching to District Nurses on frailty… now are you sitting comfortably?
British Geriatrics Society 