Author Archives: James

Palace of Care – Welcome to Hospice – Part 3

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Photo by Sebastian Staines on Unsplash

What the heck was going on? I was in a senior leadership meeting and the receptionist asked me to come over urgently as there was a man shouting at the front desk. I went over to see what was going on and was met by a man in a leather jacket. I took him into the side room so that we could talk in private. It took me a few seconds to realise that he was hearing impaired, and that’s why he was talking loudly. I raised my own voice in order for him to hear me properly. He said that he had lost his hearing because of work, back in the day they weren’t as careful with hearing protection.

He told me that he we had looked after his wife last month, and told me her name. It took me about ten seconds before I remembered who she was. Oh right, I think I met you when your wife was with us. Sorry that I didn’t recognise you. I remember your wife really well, she was a nice lady. Two days before she died, she had visited another patient that she had met in hospital. Even though your wife was so unwell and so short of breath, she had made a big effort to make the other lady feel better by welcoming her to hospice, that was really nice of her. He said that was what she had always been like, always helping people out.

He said that the reason he had come in was to tell us about something that he had organised in honour of his wife. In her memory he had organised a motorbike rally, from here in Auckland, to his wife’s favourite mountain. People who joined would donate, with the proceeds going towards our hospice, in memory of his wife. 120 people had already signed up and he wanted us to know, as the family didn’t have much money, but wanted to donate something in order to help others in the community. That’s what his wife had been all about, always thinking of others.

I thanked him for thinking of us and for organising the fundraising effort. Your wife was a kind lady, and she would be proud of your effort. Safe riding.

Palace of Care – Welcome to Hospice – Part 2

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She had spent her whole life looking like her sister. They were always compared to each other. The older one is taller, the younger one can sing better, the older one can run faster, the younger one is better at Math. Despite all of the comparisons the two sisters had always gotten along fine. Their relationship had started nine months before they were born, they hadn’t just been room-mates growing up, they had actually been womb-mates right from the start. Identical twins who looked the same on the outside but were actually different people. Their life paths had followed each other closely before wildly diverging at the age of 26. The older one became unwell two years ago, the younger one carried on with her life.

The family had been scared of hospice, they didn’t really know what it was all about, but most people associated it with death and dying. Not something that is usually discussed in the Island culture. They resisted the hospital palliative care nurse’s attempts to send them over. What changed the older one’s mind was another patient on the same ward. A Maori lady who had been in hospice before. She had told the family what it was like, that it wasn’t a scary place at all, that on a previous admission, that they had been kind and were willing to do things in the traditional way. This lady was actually going to be heading over to the hospice that afternoon. She convinced the older one and the family that going to hospice to control symptoms would be a good thing.

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Palace of Care – Welcome to Hospice – Part 1

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When the hospice nurse had suggested an admission into hospice she really had to think about it. Did this mean that she was about to die? Was that why she had suggested I go in, because they thought that I was about to die? They denied it, and said that they wanted me to go in to help control my breathing and distress. I asked my family and they were scared as well, but knew that I needed help. We decided to give them a go, but man we were still nervous about it.

Turns out we didn’t have to worry, the people were friendly and nothing seemed too difficult. The doctors and nurses started working on my breathlessness, and by the next morning I started to feel better. I met a number of the team members before I headed home a few days later. We had been worried that when you’re admitted into hospice that there is only one way out, being wheeled out by the undertaker. When it was time for me to go home, I walked out the front door.

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Bedside Lessons – 20 – Crossing the Line – Part 1

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I was working on the liaison psychiatry team in my final year of medical school. I went to meet a patient that had self-referred, which was unusual. Psych liaison provides psychiatric input for patients who also have medical issues that have brought them into hospital. I went with the nurse specialist to see the patient, an Englishman in his mid-thirties.

Work had brought him and his Latin American wife across the world. He was a nature documentary maker and had been based in the lower South Island filming the local wildlife. Just before Christmas he became unwell with a severe nosebleed, which required hospital intervention. Simple blood tests revealed grossly abnormal results. Acute Myelocytic Leukaemia (AM bloody helL) was the shocking diagnosis which destroyed their plans for Christmas and life in general. An urgent admission was arranged to our hospital’s Haematology department, which served the entire region. Harsh chemotherapy needed to be started otherwise our patient would’ve only had days left to live.

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Palace of Care – Like father, like son.

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The little old Chinese man, looked so pale, he didn’t know what to do with himself. His short-term memory had been impaired for some years but had worsened in recent months as he deteriorated.

We both used our second language to communicate with each other, Mandarin. Both speaking with thick accents, but able to understand each other. His supportive daughter had come over from China to look after her parents. They had lived in New Zealand for over twenty years.

He had always been terrible at reporting his discomfort. His daughter talked about when he had appendicitis and had not told anyone until he almost died of an intra-abdominal infection after his appendix had burst. His stock answer would be to say, “I am fine,” but his body language was a give away for his wife and daughter. He didn’t let anyone know that he had painful shingles until he was found writhing in bed, crying because of pain, telling his family that the pain was so bad that he wanted to die.

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Palace of Care – What’s in a name?

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Photo by Tim Mossholder on Unsplash

She was transferred from hospital into hospice at the end of her life and only had days left to live. End-stage cancer had taken complete control of her body. We were handed over that it was important that we respect her wishes especially when it came to calling her by her proper name. It was a name that she had to fight for, that she had won for herself, but at great cost.

Not everyone understood her wishes. When her relatives came to see her they brought old family photos, and called her by a different name. She looked different in the photos, much younger, and dressed in different clothes. We were all young once. She was becoming less responsive as each day passed and her family talked about someone who sounded different to the patient that we had only a short time to get to know.

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Palace of Care – Saying No – Part 3

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He was admitted because of uncontrolled nausea and vomiting. We thought it might be a malignant bowel obstruction but his bowel sounds were normal. He would vomit at least three times a day. Strangely the vomiting didn’t seem to bother him, in fact at times he and his wife seemed happy after he vomited. We weren’t sure of what was causing his nausea and vomiting, his blood tests showed evidence of dehydration, but there was nothing obviously reversible going on to explain his symptoms. He looked unwell and after a few days on our ward he appeared more gaunt. Our attempts at controlling his symptoms were not working, we hadn’t solved the mystery yet, until we noticed the half-filled blue glass bottle on his table. “Keep out of direct sunlight.”

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Palace of Care – Saying No – Part 2

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My usual approach to complementary or alternative therapies is to try to keep an open mind. A lot of treatments do not have much evidence-backing but can be important to the people wanting to try them. A lot of the patients I see have exhausted all that Western medicine has to offer, thus they seek alternatives. Some of these treatments may be expensive in financial and other costs. I am supportive of a patient’s right to choose whatever treatment they want. If it makes them feel better, who am I to judge?

I do draw the line if an alternative treatment is causing harm. First do no harm is the first concept they taught us in medical school, but it is not a concept taught in all therapy schools. Rarely have I directly intervened when it comes to my patients receiving complementary or alternative treatments, but that does not mean that I would not do so.

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Palace of Care – Saying No – Part 1

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In his professional life he was used to taking charge, of taking control and at times this bled into his personal life as well. His wife’s mother was unwell with widely spread cancer, she had been admitted into the hospice for symptom control of pain, breathlessness, and nausea. He had always been close to her right from their first meeting, he was probably closer to her than he was to his own parents, and even called her Mum. She had always been there for her children and their partners, and he really wanted to be there for her. He wanted to make sure that she was treated right, and he had a small inkling that his manner might come across as intimidating, but that was useful in police work. He just wanted to make sure that Mum was being well looked after, it was what she deserved.

She was a Pasifika lady in her early 60s, with end-stage cancer to her liver, lungs, and many bones. She was the frailest patient in our inpatient unit and I was worried that she might be dying. She was well cared for by her family who were always with her. Her husband of similar age, two daughters and a son-in-law, who I found out was a police officer. He had already caused a bit of a disturbance in the unit as he had spoken in an aggressive manner to some of our nurses, and was impatient. The family were all tired, worried about our patient, and stress levels were high. The family members all seemed to defer to the policeman who had taken on the role of family spokesman. The patient was fatigued but had not slept much in the past days because of uncontrolled pain. The first time I saw her I thought to myself that I wouldn’t be surprised if she crashes quickly.

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PIANO Lessons – First meeting

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Years ago I received a cold-call email from a teacher at one of the local primary schools. Naomi Lees had read my bio on the Hospice New Zealand Conference website. This was a conference at which I was a keynote speaker. Naomi said that from my bio it sounded like we had common interests and she invited me along to her primary school’s networking meeting.

I had always loved the idea of compassionate communities and thought it would be a good opportunity to connect with one of the local communities we serve. I was keen to meet Naomi, her school principal and other community members, at the PIANO (Papakura Information and Networking Opportunity) meeting. A cool name and I wondered what kind of music we would produce together.

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