RAB 2019-2020

It comes from insula, they say.

(If etymology is your play).

From Latin, meaning “island,”

But here, no sea nor golden sand.

To be on one’s island – what does that mean?

For some, more strain than there has ever been.

To not leave their homes is incarceration.

All they can feel is resentment, frustration.

The recovered addict from cocaine

Craves his kickboxing to stay sane.

The lady with high blood sugar

Who daren’t run outside (she feels vulgar).

Overworked parents who have to home-school.

Oh screw it! There are no more rules.

Let’s just put on “Disney Plus,”

Now do your homework please - no fuss.

But these poor children, all they desire

Is to see their friends, kick a ball, be inspired.

For some, these islands are places of fear.

Threats of domestic violence domineer.

Some children may not get their main meal.

(Perhaps a slice of bread, or an orange to peel).

How do we cease this negative spiral

And stop this resentment going viral?

Those same walls that kept out the wind and the rain

Are going to make us completely insane.

Indeed for many – far more than we know –

Isolation is simply normality. How so?

Being housebound is part of everyday life.

Do we think of these people, their woes and strife?

A lady – let’s call her Lucy – in East London.

Her little front garden, a place of abandon.

The stroke that rendered her unable to walk.

Paralysed down one side, but able to talk.

She told me it had been at least five years,

Since she had been outside, in tears.

The mere five steps to her front door

Left her stranded on her island, washed ashore.

Her grandchildren visited often, she said.

“Thank God for them, else I’d be better off dead.”

A man, let’s call him Jim for short.

Had a car accident: he never thought

That aged 33 and eager, with everything ahead,

He would be paralysed from the waist down: “don’t drink and drive,” he said.

Guilt and depression consumed him, ate away at his bones.

How awful to feel so terribly alone.

Seven years later, he sits in his flat.

What he wouldn’t give for a cup of tea and a chat

Exhaustion from myalgic encephalitis,

Painful joints from osteoarthritis

Too breathless to walk, with chronic bronchitis.

Incontinence might strike, oh that dreadful colitis.

Palliative care from incurable cancer,

Unable to walk or talk from dementia.

The reasons are countless

But only now has isolation found the rest of us.

Indeed, physical isolation does not reign alone

Paired like a demon: social isolation, on the next throne.

The pandemic of loneliness was already rife.

Who do you talk to when you’ve lost your wife?

They say it’s as bad as smoking 15 a day.

So how many are there, in the UK today?

Nearly 400,000 don’t talk with others for a week.

(That was before Covid; it becomes more bleak).

A 96 year old man – let’s call him Dave.

Incredibly able for a man of his age.

Bright as a button, sharp as a knife.

He tells so many tales of his old Navy life.

But still needs help with cooking and cleaning,

And washing too (he finds that chagrining).

The carers come two times a day,

(He does have family, but they’re far away).

These ladies were lovely, put a smile on his face.

They were the only people that came to his place.

Indeed, the only people he spoke to at all.

But who now, who can he call?

Now that Covid has swept the nation,

No more visits “for his protection.”

“We must help the elderly!” people now say,

And we all chipped in, without delay.

Reaching out to our neighbours with supplies

A whole new community, in front of our eyes.

A community that had always existed.

But only since Covid, our help enlisted.

We must strive to continue this net of support.

For Lucy and Dave, no phone call is too short.

They couldn’t possibly “skype” or “zoom,”

But for the younger people, social lives resume.

Let’s build more bridges between our islands.

Construct a metropolis of love: let’s all join hands.

To appreciate this new way of living

We must be try to be more forgiving

Of ourselves, our neighbours, our daily lists

Kindness, meditation, that cheek unkissed.

A journey of quiet discovery

It might bond us, in our recovery.

On these islands, there are golden sands and more

We just have to find our way to the shore.

For many of us, although isolation at home is highly alien, it is temporary: the boredom, anxiety and frustration will eventually pass. But when reflecting upon the effects of isolation upon society, I was struck by the number of people for whom spending every day at home is normality.

Working as a carer before medical school highlighted to me how different people cope with relative isolation inside their homes. I worked with several elderly clients who were perfectly content at home, many of whom received frequent visits from family. But for many, their sole source of human contact was us, their carers. Drawing upon my experience with “Dave,” our daily chats were as essential a part of his care as preparing his meals. Many people are currently not receiving their normal care at home: partly due to care staff self-isolating, and several people are also refusing care for fear of catching the virus.

Physical isolation can be accompanied by social isolation, which can in turn lead to loneliness. However, these three concepts can be viewed as separate and independent entities(1). Whereas physical isolation signifies a separation in space, social isolation means a lack of social contact, and loneliness refers to feeling alone. Both social isolation and loneliness can still occur in the physical presence of others, and equally, there are many people who experience social isolation but do not feel lonely.. In recent years, the advent of multiple electronic platforms, such as video calls, has enable the connection, and indeed reconnection, of relationships with others, even across the other side of the world. Thus physical and social isolation for many, are no longer inevitably intertwined. However, although there are people in the elderly community who are able use these technologies, no doubt that to many, such platforms are completely inaccessible, thereby heightening their relative social isolation even further.

I admire the British public for the recent outreach to the elderly in our communities, and others who face difficulties leaving their homes. But I hope that this support continues beyond Covid-19. This is a time of adaptation for us all. Can we adapt as a society going forward to meet the needs of this silent population? Studies have showed benefits of implementing video calls among residents of nursing homes on depressive symptoms and loneliness(2,3) – would there be scope to extend this support to people at home?

1. Menec et al. (2019) Examining individual and geographic factors associated with social isolation and loneliness using Canadian Longitudinal Study on Aging (CLSA) data. Plos One 14(2): e0211143.

2. Zamir et al. (2018) Video-calls to reduce loneliness and social isolation within care environments for older people: an implementation study using collaborative action research. BMC Geriatrics 18 (62).

3. Tsai HH et al. (2010) Videoconference program enhances social support, loneliness, and depressive status of elderly nursing home residents. Aging Ment Health. 14(8):947–54.