Category Archives: Education

Palace of Care – Flashback

Posted on by
Reply
Photo by Marek Studzinski on Unsplash

It had been over two years since we had last met. Memories of the day came back to me in flashes.

I welcomed the family to our venue, meeting family members who had travelled from afar to be there. I remember not wanting to intrude, to be helpful but not in their way. This was her day and I didn’t want to waste any of her precious time.

I recall how it felt to walk back into the room three hours later. With experience, you can measure the emotional temperature of the room in an instant. There was warmth, there was talk of happy memories, there was love. There was laughter, there were tears. Favourite foods and drinks were being shared. There was champagne, there was Strawberry Rocky Road ice cream on sticks. People were gathered for a celebration of a life. A life cut short by major illness, a life interrupted by debility and indignity.

It was still early on in our experience, only the third time we had hosted. It was nice. In the last hour, everyone had the chance to say their goodbyes in the privacy of the bedroom. The doctor arrived and was not constrained by time, he wanted her to take as much time as she needed. It was all about what she wanted, that’s why we had all gathered together. To be with her at the end time of her choosing. Family, friends and healthcare professionals assembled for a final farewell.

The room was full to the brim. The question was asked again, “Are you sure you want this.” The same slurred but steadfast answer, “Yes,” steely resolve obvious in her focused eyes. Making this decision had brought her back not just some control, but had also brought back her determined personality. She had seemed more like herself than she had for years. She was going to leave on her terms, of her own volition.

The last thing she said was, “I love you,” as she hugged her father. She held her son’s hand as she fell asleep for the final time.

Death.

Assisted.

Love.

Relief.

Tears.

Hugs.

Rest.

In.

Peace.

Brave.

Lady.

Proceedings of the RRIPM Round Table Workshop

Posted on by
Reply

The Rural and Remote Institute of Palliative Medicine (RRIPM) has released a draft of the proceedings of their Round Table Workshop held last month in Canberra. Participants included consumers and community advocates, clinicians and managers, college and peak body leaders, as well as state and federal government representatives.

Recommendations from the workshop will guide implementation of the next phase of the RRIPM project:

  1. Maintain independence, with clearly defined roles and expectations when working in partnership across participating organisations
  2. Advocate for the establishment of a tri-partite group [RACP, RACGP and ACRRM] to strengthen training alignment
  3. Launch a trial network across training ready locations
  4. Consider proposed actions relating to education and training, leadership and governance, capacity building and relationships for implementation in Year 1 to Year 3
  5. Seek guidance from the Office of the National Rural Health Commissioner, and other jurisdictional representatives to identify future funding sources

To receive regular updates on project progress please register your interest with the project team via email rripmproject@anzspm.org.au

rripm-round-table-workshop-summary-of-proceedings_finalDownload

Palace of Care – Far Too Young

Posted on by
Reply
Photo by Rhii Photography on Unsplash

For most of my time in medical school, I thought I was going to train to become a paediatrician. That all changed after I went to Taiwan to do my medical elective in Paediatric Oncology. After five weeks on the child cancer ward, I realised I couldn’t become a paediatrician. I found I couldn’t handle working with critically unwell and dying children. I decided to become an adults-only doctor and didn’t look after children anymore.

Fast forward 11 years and I was in the final year of my Palliative Medicine training, and I was working in the local hospice. In New Zealand, the definition of adults is those 16 years old and over. We had admitted a 16-year-old immigrant schoolgirl and she was dying of metastatic bowel cancer. It is highly unusual to have bowel cancer at such a young age. What she had was aggressive and deadly. Physically it was challenging to control her symptoms but that was the easier part of dealing with her case. Looking after such a young person made the case difficult for me and other staff members. She was the same age as some staff members’ children or grandchildren. Most of us were not used to working professionally with adolescents.

We had admitted her for end-of-life care and it looked like she had limited time left. The prospect of her dying alone made all of us feel uncomfortable. The girl needed parental support but the girl’s mother had died and her father had to go back to their home country to deal with urgent matters. She had no other family and was alone in New Zealand, apart from similarly aged school friends. How could we help her through this?

Her cries for help would be answered by a church pastor, who stepped in and became a mother figure for our young patient. This lady moved in and provided motherly support during the toughest of times. The pastor and her husband (also a pastor) arranged for the girl’s father to return to New Zealand. The pastor stayed with the girl at our hospice for the last weeks of her short life.

It was sad that our young patient was dying, but it was so nice that the pastor was there to provide maternal support. It was good to know that there were still some good people around who could be counted on. Our patient was kept comfortable and died after her father had come back from overseas. In many ways a memorable case of someone who died far too young.

Specialist Palliative Medicine Training in Rural Australia – A Scoping Review

Posted on by
Reply

The Rural and Remote Institute of Palliative Medicine (RRIPM) has released a draft of their scoping review into specialist palliative medicine training in rural Australia and are now inviting everyone interested in improving rural palliative medicine to provide feedback before 12th February 2024 by emailing the Project Manager at RRIPMproject@anzspm.org.au

rripm_scoping_review_consultation_draftDownload

I think therefore I am? – Greetings

Posted on by
Reply
Photo by Katie Moum on Unsplash

I work in one of the most ethnically diverse areas in the southern hemisphere, South Auckland. There are people from many different places who now call this area home. English may well be a second, third or even fourth language to many of my patients and their families. Many different native languages are spoken and on any given day our inpatient unit may be full of people representing many different groups.

I make an effort to learn how to say simple common greetings in the native language of my patients. Over many years I have gathered a list of these greetings. If I don’t know the standard greeting I will resort to an internet search for the appropriate greeting before I meet the patient. A simple “hello” in their native language is usually appreciated and is the first step in building rapport. If I know more words in their language I’ll make use of as many as I can during the rest of the consultation. When trying to make a connection you usually only have one shot, make it a good one.

SCM – Self Care Microdoses – A walk in the garden

Posted on by
Reply
Photo by Drew Coffman on Unsplash

I have had to focus on self care this year as it has been challenging at times. I’ve had to shift my focus away from saving up all my self care for a holiday as I need more regular doses of self care. In fact if I had not done self care activities on at least a daily basis I would be in much worse condition than I am at present.

I’ve been working on microdoses of self care. This might be as short and simple as a five minute walk in the hospice garden. This is a combination of leaving my usual seated in front of a computer working position and going outside. Five minutes of fresh air and occasional sunshine in between the recurrent episodes of heavy rain we have experienced in Auckland this year. A small dose of exercise for my body which is at risk of pressure injury from prolonged sitting. A chance for my eyes to focus on objects which are further away than the screens I look at while doing computer based work. To feel the wind through my hair. To smell the flowers and the trees.

There is a slightly more shaded area of the garden path I spend a bit more time in. If you stop at the right spot and close your eyes you feel almost transported into a forest. You hear the wind rustling through the trees. There is birdsong from nectar feeders who have had plenty to eat in recent weeks. I walk around the garden and I might bump into some of the many volunteers who keep the garden looking its best. I try to stop and chat to the volunteers as often as I can. To thank them for what they do for our organisation.

Five minutes, 500 steps. A short workout for my otherwise sedentary body. A couple of times per day on a good day. It all adds up, every little bit counts.

What self care activities have you done for yourself today? What can you do for yourself that will take five minutes?

I think therefore I am? – Please don’t leave me.

Posted on by
Reply
Photo by Omar Ram on Unsplash

We humans are social animals. Without companionship we do not do so well. Loneliness is a major health risk factor for the development of many illnesses. The less socially connected we are the worse we may feel emotionally but also physically. Acts of human connection enliven both the donor and the recipient. It feels good to help someone else out. A win-win situation, you both get something out of it. It feels good to belong to something. To belong to a group or a tribe.

How does it feel when people with life-limiting illnesses are discharged from clinic for the last time. They might’ve been seeing their care team for years in some cases, all of a sudden they have lost the support. They might feel bereft. The closure of a relationship. They had always been there for me and now they are not. A void is created, can it ever be filled by anyone else? A feeling of rejection, of abandonment may be experienced. A shove off the edge of a cliff, into free-fall. A tie severed. We will never meet again, we just had our final goodbye. I thought it would last forever. People change over time, no matter how much they try to stay the same.

Goodbye, I have nothing else I can offer you, but you can come and see me again in six weeks. I wish you all the best. Please take care.

You said you’d always be there for me, through the worst while hoping for the best. You left me hanging. I didn’t know what was happening, the world seemed to spin around me like a not so merry-go-round. You told me to leave but I have no other place to go. I still need help. What did I do to deserve this? Was it something I said? Was it something I chose? Can we just talk? Please?

Please don’t go…

Palace of Care – Three of a Kind

Posted on by
Reply
Photo by Joshua J. Cotten on Unsplash

A severe deterioration had been expected within days of their arrival. A review of their medical records pointed towards a poor prognosis. There didn’t seem to be much time left. We tried our best to prepare the patients and their families for imminent death. A few days passed and none of them died. Maybe it was good control of their symptoms. It could’ve been the less stressful environment of the hospice inpatient unit. Was it access to fresh air? The better food? Flexible visiting hours and the ability for family members to stay overnight in relative comfort. Something kept them alive. None of them wanted to die. They all had too much to live for.

Different origin stories. Different walks of life. Different family relationships. Different husbands. Same hospice. Same time. Same staff looking after them.

Deteriorations happened and somehow they recovered. Again and again, they kept beating the odds. Staying alive in a mostly comfortable state. Their loved ones were along for the roller-coaster ride with seatbelts off.

Worsening symptoms required changes to medications. Their worsening overall condition led to discomfort and uncertainty. Was this the start of the final deterioration? Had their bodies decided which path to take? Which destination to go for? How much time was left?

We didn’t know the answers to the questions posed. We had no way of predicting what would happen. Instead, we would monitor their progress over time. Give them time to declare themselves. We would continue caring for them no matter what happened.

Palace of Care – Easter Face/Off

Posted on by
Reply
Photo by Jerry Yu on Unsplash

Easter was about to arrive. At the last minute, I asked my wife and daughter if they had bunny ears I could borrow. They replied yes but they were unable to or me. Just like an Easter Egg a cunning plan was being hatched. Leftover Christmas decorations were examined and a pair of antlers were found. With the addition of cardboard, staples, and a hair tie, bunny ears had been produced out of thin air.

I wore the bunny headband for my whole workday. Anything for a laugh. The patients and their family members bore witness to my madness.

Later in the day, I met the son of one of our patients. He didn’t have clown makeup on and was of a serious demeanour. Facial tattoos adorned both cheeks. A proud member of one of New Zealand’s infamous gangs. We were both in the room because of the patient. Both of us trying to do the best for him. I tried my best not to stare at his facial tattoos. He tried his best not to stare at my bunny ears.

“Happy Easter,” were the first words I said to everyone in the room. Reading the logo tattooed on the son’s cheek I found out he was a member of team blue. I’d had a number of dealings with various members of this gang in the past. He stayed outside of the room but popped his head through the open window. I spoke to his father to see how I could help. Pain, nausea and hiccups were the main issues troubling my patient. He knew he was critically unwell and agreed with my plan to calm down his symptoms. His wife couldn’t keep a straight face as she tried not to laugh at my bunny ears. On that lighter note, I left the room.

A few minutes later our charge nurse had to go back in to talk to the patient’s son. He was smoking cigarettes on the balcony outside of our patient’s room. She asked him politely to stop smoking as it was a health and safety risk as our balcony is wooden and at risk of fire. He put out his cigarette without any comments or fuss. We have rules we have to comply with otherwise we’d be shut down.

We look after all sorts of people from all sorts of backgrounds, and all sorts of families. Even hardened criminals can be vulnerable when their loved ones are dying. They need to be treated with compassion and professional courtesy regardless of our own personal opinions. They want our best professional opinions when they meet us at work.

Palace of Care – Shorts 3

Posted on by
Reply
Photo by Pars Sahin on Unsplash

Will another CT scan make things worse for her?

The scan itself wouldn’t make much difference. But the energy used to go out and get it would not be a good use of the precious time she has left. We only do tests if the results might change our treatment plan.

I wouldn’t recommend a scan as we already know what’s going on.

It would make it more real for us. We know what is happening, without the tests.

But she really wants it.

We can’t request scans ourselves. You’d be better off contacting the Oncologist, to ask his opinion.

How much time does she have left? Will she still be alive in two weeks’ time?

I don’t know. She might still be alive, or she might not last that long.

Is there anything else that we can do to treat her?

No, the Oncologist has tried all available options. If there was anything else available he would have done it already. I’m sorry.

We don’t want to be sitting and waiting. We want to do something.

Her time has become so precious.

Nod.

We will always be trying to do our best for your wife. And sometimes that might mean saying no to things you ask for.