Monthly Archives: March 2022

Palace of Care – Hold On

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Photo by Hu Chen on Unsplash

We’d been trying to admit her for weeks, but she had not been keen. We had her on the admission list for a whole week but she said that she had to sort out something for her children and couldn’t come in. I thought that it might be an excuse, as a lot of people are still scared of hospice. Most people have not had anything to do with hospice but they may have some pre-conceived idea of what hospice might be. Often this is inaccurate, and can generate a lot of fear.

It took some convincing by the hospital palliative care team before she would finally agree to coming in to hospice. She was still nervous but her favourite cousin had promised that she would go in with her. They had grown up together and they were best friends, but this had been taken to a completely different level once the cancer diagnosis had been made five months ago. Something was wrong as she had lost a lot of weight, without trying to. Life had been busy for many years with her five children, and her partner could not always be counted upon. It was her cousin who had attended all the Oncology appointments with her. Her cousin had been there for all the chemotherapy sessions. Having her cousin accompany her to hospice was comforting and if there was anything scary, she would be there for her.

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Bedside Lessons – 21 – Overcast Sky

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Photo by Malte Schmidt on Unsplash

100 years ago, when I was still a trainee registrar, I asked myself, “what were we going to do?” I was about to admit the kind of patient that hospital doctors would be eager to transfer to the local hospice. I’d done exactly that in my previous hospital role, but I was then working in the local hospice and would have to deal with the situation myself.

She’d been nauseated for two weeks in hospital. They had tried everything and nothing had worked. The last weeks had been rough for her, and even in that short amount of time she had lost weight. Her appetite was suppressed to nothingness, as she felt too sick to eat anything. The mere sight of food put her off completely.

After I finished the admission I felt miserable myself, some of her misery had rubbed off on me. Was this transference, or counter-transference? Something about the situation that she was in made me feel similar to what she was going through herself. What to do? One option was to stop all treatments and start all over again. That’s what I did.

The next day I found myself leaving the miserable lady until the end of the ward round. I did not want to catch her misery again in the fear that I would spread it throughout our inpatient unit. I was trying to avoid her as yesterday’s experience had made me feel worse for wear. She had made my heart sink and so I put her off for as long as I could. Things hadn’t really changed much, and I had another dose of misery before lunch time.

By day three I felt bad for being unsupportive of the patient and I promised to myself that I would try harder to connect with her and decided to see her earlier in the ward round. It wasn’t her fault that she was so miserable, it was the illness making her so, and we hadn’t been able to control her symptoms. Walking into her room I braced myself for the tidal wave of negativity. I held onto the door jamb as I entered her room, expecting to be sucked into the black hole of her misery.

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Palace of Care – No Surprises

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Photo by Raychan on Unsplash

Is it the medication making him drowsy, there’s been a big increase in the medications since yesterday, I want them cut back down again.

I’m really worried about your Dad. I don’t think it’s just the medications changes causing him to change. His pain and nausea have worsened a lot over the past three days. It’s a shame as he was doing so well the other day.

It’s not right, he should be getting better, not going backwards. You know he was an alcoholic, I’m worried that he’s become addicted to the pain killers. He hates being confused, that’s what he was like when he drank, he really doesn’t want to go there.

I don’t think that addiction is the problem here, his pain and nausea are worse, I think it’s the cancer causing this. If I decreased his medications now, he would become much more uncomfortable. I don’t want him to suffer.

What about his radiotherapy appointment, that will give him a boost right?

He’ll get the side effect right away, but the benefit might not occur for some weeks. I’m really not sure if he has weeks left to live. I’m worried that if he keeps on deteriorating at the same rate, that he might only have days left to live. We usually say if you are changing over months, you might have months left, same applies to weeks and days.

Really, you think he might only have days left?

Yeah, so I’m not sure that he will be well enough for radiotherapy. I know he wanted it and so do all of you, but I’m not sure that he will be well enough to make the appointment.

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