I think therefore I am? – Alcohol hand-rub and the clinical application of Mindfulness

Mindfulness in recent years has become increasingly fashionable throughout the world and is popping up as part of treatments in Psychiatry, as part of the rehabilitation of prisoners, and even in the Palliative Care world. Is it really all that new or is it the repackaging and re-marketing of what Buddhists have been doing for thousands of years? What follows is my own personal experience of Mindfulness and how I apply it to my practice of Palliative Care.

I had been interested in meditation since the late 1980’s when I read in a Batman comic that when he was completely exhausted, instead of sleeping, Batman would meditate briefly. This would leave him refreshed and able to go out and fight the bad guys again in a few hours’ time. Having never been a fan of sleep in general, the idea of a sleep substitute really appealed to my younger self. Throughout the 1990’s I explored various types of meditation practice, but had largely given up by the 2000’s.

In September 2013 I had signed up, in my usual last-minute fashion, to a pre-conference workshop at the APHC 2013 conference held in Bangkok, Thailand. Having registered for the workshop very late I was left with only one option. The workshop entitled, “Mindfulness in Clinical Practice,” turned out to be the highlight of a very enjoyable conference.

Less than a week later I was in Montreal, Canada for the 1st Whole Person Care Congress in which a number of the sessions and workshops were devoted to Mindfulness. It really had become the flavour of the month on a global scale, but did it spur me into a programme of regular Mindfulness practice? Heck, no!

It wasn’t until October of last year that I decided to give Mindfulness meditation a proper go, via the Headspace app. This easy to use program of guided meditations has led to me doing 236 sessions and has had various benefits. A greater sense of calm, better observation skills, greater ease at falling asleep, and even benefits for my patients.

What is the connection to alcohol hand rub?

As a Medical Registrar the importance of clean hands was drilled into me by an Obsessive/Compulsive trait possessing Physician who went through 500ml of Alcohol hand rub per day in his quest to limit the spread of hand-borne contagion. Apologies for the next sentence…some of it rubbed off on me. As part of my own personal ritual, prior to knocking on the door of patients, I will douse my hands with a good squirt of the alcoholic jello-shot. While I am rubbing my hands together I take a deep breath in, and slowly release it. This brief amount of time allows me to centre myself so that I can be truly present in the clinical moment that follows.

Being in the moment with the patient allows me to “tune in” to what they are going through, and to gift them my full attention. I’m not thinking about what is for dinner, what my plans for the weekend are, what an interesting shadow is being cast on the wall, but instead I am able to focus on what they are saying, verbally and non-verbally. Of course this doesn’t happen with every single patient encounter that I have, but when I am “in the zone,” the patient’s situation becomes much clearer to me. I end up with a much better idea of what they want and need. This fleeting moment full of human mind connection still surprises me at times. It feels like it is a little piece of magic, something to be approached with wonder.

The patients seem to enjoy it too.

At the end of the visit I say my goodbyes and reverse the entry ritual. Another squelch of disinfecting viscous chemical is applied to my hands, another deep breath is taken and released. The ward round continues.

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Palace of Care/I think therefore I am? – Announcement

Head in HandsPhoto by Alex Proimos under Flicker Creative Commons

To my Palliverse team-mates and our internet friends,

I just wanted to say that it has been a real pleasure working with you all on our Palliverse adventure.

I think we all deserve to give ourselves pats on our backs as we have achieved a lot in our limited collected spare time.

Unfortunately I will have to leave the team, and I apologize in advance for doing it in such a public fashion.

I have thought long and hard about it and with much regret I have to make the right decision for myself and my young family, at this stage in our lives.

It is with a heavy heart that I must bid you all farewell for now. It has been fun while it has lasted and I’ve been very fortunate to have you all in my Palliative Care life. Continue reading

Palace of Care – After the moment

Currently… you look so sad.
Currently… you look so mad.
Currently… you look so bewildered.
Currently… you look so disempowered.
Currently… you look so past your best.
Currently… you look so, ‘the worst of the rest.’
Currently… you look so useless.
Currently… you look so hopeless.
Previously…we; were friends.

James

Palace of Care – Musical Interlude

After a tough fortnight at work I decided to change things up a bit at our Multi-disciplinary team meeting this morning.

We’ve been using an iPad to take notes from the meeting for a while now, and today I tried to make it a more multi-media affair.

As well as recording the patients’ stories I also tried to match each of them to an appropriate piece of music.

The rather diverse playlist and patient list eventually became:

Tammy Wynette – Stand by your man – after discussing a man whose ex-wife had returned to look after him.

Imagine Dragons – Radioactive – the correct pronunciation of a patient’s surname.

Avril Lavigne – Complicated – a patient’s complex family dynamic.

The Black Eyed Peas – Where Is The Love – a patient’s long-term relationship with their spouse.

Alicia Keys – Falling – a patient who had repeatedly been falling…over.

Bob Dylan – Blowin’ in the Wind – a patient with malignant bowel obstruction who had started passing flatus.

Cheers,

James

Palace of Care/I think therefore I am Special Edition: #getjakbak became #gotjakbak

More later…currently too tired

Thanks again for all the help.

Cheers,

James

Palace of Care/I think therefore I am Special Edition: We will #getjakbak !

Thank you again for all of your pledges and donations. A special note of thanks to Sean Coleman and his team at Air Ambulance New Zealand who will be transporting us to the airport tomorrow morning. He has donated his services which would usually have incurred a very competitive fee  of NZ $595.00 Thank you Sean for your time and sage advice. Cheers, James

Palace of Care/I think therefore I am? – Special Edition: Palliative Care Mission of Mercy – #getjakbak

Hi everyone this is a last minute fundraising plea to everyone as private citizens.

I am organising for our non-resident patient “Jak” to return back to the Islands. (Real name changed.)

Jak is a 44 year old man with a large abdominal mass found to be cancer with spinal cord compression + lung mets, intra-abdominal abscess resistant to IV Ertapenem – causing fluctuating levels of sepsis.

Has been trying to get back to the Islands for the past month, but hampered by critical illness.

He has stabilized at present and we have one shot at getting him back tomorrow morning at 0915. He can travel if escorted by a doctor. The most discounted fee for a doctor I could negotiate was $3800, which the family could not afford.

I have volunteered my services to look after him on the flight to help Jak get back.

The family with the help of the local Pasifika Community, have fundraised $7400 of the required $10720. They need $NZ3320 by 5pm today in order for Jak to get back home. i.e. in 1.5 hours have received pledges of $720 so far. 1536hrs

So close but yet so far…

Please forward this email on to your own teams and networks.

Every bit pledged will count. I will consider all pledges of assistance.

For those interested in following the journey I will attempt to live tweet/blog it through Twitter:  @palliverse #getjakbak and www.palliverse.com

Thank you for your consideration,

James

1550hrs – $1320
1557hrs – $1520
1611hrs – $1790
1613hrs – $1990

Just need $1330 to grant this young man his dying wish of going home to his family. We can do this team!

1617hrs – $2190
1620hrs – $2210

Only $1110 to go to #getjakbak

1629hrs – $2260
1630hrs – $2425
1631hrs – $2475
1630hrs – $2775
1634hrs – $2925

Only need another $395. Well done team!

1640hrs – $3005
1642hrs – $3085
1642hrs – $3150
1655hrs – $3350
1700hrs – $3400

Thank you everyone we have done it! Any extra funds raised will go towards payment of hospital fees.

Thank you for helping your fellow man. I am proud of you all!

James

I think, therefore I am? – Please take a seat

What the heck was going on in the lounge? A patient’s family and the doctors were sitting on the floor with their legs crossed. Were they about to break out into song? Kumbaya my lord, Kumbaya…? Was this part of the Hospice Yoga Initiative? Mat-time at a new New Zealand charter school? No, it was actually a family meeting.

Family meetings are common occurrences in healthcare settings and are organized in order to convey a point of view, or to try to bring together disparate points of views. These events may actually be the first chance that some of the key stakeholders, i.e. the family and the healthcare team, actually have to meet each other. The first time that the next of kin has made time to meet with the health care team looking after their loved one. First impressions as within any first meeting are important. As you can only meet for the first time once, you’d better do your best to make sure it goes well. In order to establish a trusting therapeutic relationship between the patient, their family and the health-care team, rapport must be established quickly. Every encounter can count, but not everything can be planned for. Continue reading

Palace of Care – Mate

I thought to myself while I was talking to him today, I’m really going to miss this guy, who I’ve been calling mate.

Some people will really pull on your heart-strings. Mate is one of those people. He’s really unwell, and his time is very limited, but he’s still charming the ‘socks off’ of all of the ladies. He’s always very polite, and well-mannered. I’ve been looking after him for the past week or so, and he has been deteriorating on an almost daily basis. He never complains and has never liked to cause a fuss. He’s a shy man, who doesn’t want to be a nuisance, I’ve had to almost beg him to ask for pain relief when he needs it. He has been through an awful lot of pain. It has improved since he came under our care, but it is still there. He has never complained, either before or after his illness was discovered.
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Palace of Care

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Hi everyone,

Join me in sharing stories from the lighter/brighter side of Palliative Care.

Cheers,

James