I’ve been practising Mindfulness meditation for the past seven years and I feel that it helps me to tune into my patients’ situations better. I still do my usual alcohol hand rub routine prior to entering each room, to bring myself into focus, to be present in the room.
I need to take in the whole atmosphere of the room, who else is in there, how are they interacting with each other. What is the emotional temperature of the space. It might be an inpatient room, an outpatient clinic, a hospital room, or at a patient’s home that I find myself.
A quick survey of the environment prior to beginning the assessment proper is useful. You look for extra equipment in the room. A commode chair can indicate difficulty with mobilising. Monkey bars or bed levers may confirm restricted independence. Is there equipment in the room, like oxygen tubing, oxygen concentrators, nebuliser or suction systems. Are there any hand held devices such as inhalers of sprays that the patient could give to themselves? Any walking aids? A sensor mat would indicate confusion and possible delirium. Not safe to transfer independently. Urinary catheter bags and tubes, and other drainage devices.
With observation alone you can find a lot of information, even before speaking to them. All of the above is assessed within the first 30 seconds of meeting someone. You also check out their visitors at the same time.
A husband and wife came to see me in Outpatient’s clinic. He had been troubled by widespread cancer and they had tried all of the conventional treatments with no effect. We talked about his case and how it was different from most cases, in that they had the means to seek alternative therapies, including one that was taught in Australia.
A large component of the treatments included diet modification. Our patient had to give up, coffee, wine and most of his favourite foods. He was subsisting on salad greens, and canned tuna and shrimp. His wife did not join him on his diet, and continued to enjoy her food and beverages of choice. Which may have made things even harder for him.
I must have really tuned into him as whilst he was talking, something inside me suddenly came up with the idea, “you’re missing ice-cream.” He confirmed that this was something else that he had to give up on when starting his diet. We talked about other things that he was missing out on, and I tried to encourage him to be less strict with his diet, and that it was important that he allowed himself to enjoy things that he liked. Psychologically it would keep him in a better state of mind as he had become sick of eating the same boring bland food every day for the past three months.
It was bad enough being unwell, but depriving yourself from life’s pleasures in totality would have a negative impact on overall quality of life. I gave our patient and his wife something to think about in an effort to decrease the stress of their overall situation. It’s important to maintain a balance in life. Being too extreme about anything is not useful, as balance is required. Too much austerity and spartanism may be too harsh to handle, especially when you are unwell.
People want to feel that you are paying attention to them, are taking the time acknowledge them as real people. People who still have many needs and wants that remain unfulfilled. We need to remember that we are dealing with human beings who are people who even at the end of life want to be treated with respect and compassion.