It had been one week since her husband passed away when she went to the cemetery to visit him. She wanted to go earlier but she had been too unwell. She was tired from the effort of walking and was grateful she could rest on the seat of her walker. She made her way slowly to her husband’s grave. In the distance, she could hear the sound of someone sobbing.
She sat looking at the headstone and replayed in her mind memories of when they were together. It was not her first experience of death, having lost her two year old daughter many years ago.
She recalled many weeks spent at the cemetery mourning her loss. But then one night she had a dream of angels in a line descending from the sky, each one bearing a candle in their hand. Then she saw her daughter but her candle was not alight. She rushed towards her daughter when she heard a voice telling her that it was her tears that kept her daughter’s candle from burning.
I love my food, and some (mainly my wife, staff members, and the World Health Organisation) would say I love my food too much. So when I hear about crimes committed against food it really annoys me. Hospital food usually has a bad reputation. Mass produced food in general is usually not as good. The recent trend in New Zealand hospitals is for food to be manufactured in a central location and then for all the food to be transported to all of the hospitals. Though this may make economic sense, it is makes no gastronomic sense at all.
This goes against treatment of patients as human beings. Patients are served unappealing material that may have had a natural origin at some point in its life time. It takes a lot of skill to transform random bits of plants and animals into things that resemble plastic in the way it looks and tastes. Patients are in hospitals because they are unwell, and it does no-one any favours when the food they are served makes them feel even sicker.
A plate of fish and mashed potatoes was an example that my cousin told me about. The fish was dry and rubbery, with all nutritional content having been consigned to the pages of history long ago. The mashed potato had given up its moral integrity. Having once lived in a hole in the ground, the potato had been harshly dragged into the light. Flayed whilst still alive, and then subjected to a death by a thousand cuts. Turned into tiny molecules of potato, smashed into uniform shapes. Then dried out along with billions of similarly shaped friends, and repackaged. Add water to make instant mash potato. Instant it may have become, but potato it was in name only.
Covid 19 the gift that keeps on giving. Why does it have to be so generous? It has affected everyone and everything in the world, and the hospice is no different. We have had to impose visiting restrictions on our patients and their families in order to limit spread of the virus. Covid restrictions and quarantine requirements have led to some of the most upsetting situations that I have witnessed during my career.
When someone is dying, it is natural to want to be with them, to support them in their moment of need. They were there for you when you needed them the most, and you want to reciprocate if you can. Even before Covid it could be difficult to travel back home thousands of miles, trying your best to make it before your loved one dies. During Covid it has been that much worse.
My patient came in because of severe pain, a common reason for admission for many of my patients. His wife accompanied him, and they both looked exhausted. His pain had been poorly controlled over the weekend, and the nights had been especially long. The medications did not seem to work for long, they gave him a brief period of respite before the pain would come right back. It was almost cruel to be granted that small packet of relief, and then it would be roughly dragged out of his grasp again. This cycle repeated itself over what felt like a long two days. By Monday they needed help and he was admitted into hospice.
I was asked by medical students, what was my favourite part of working in Palliative Care? I instantly replied, having a laugh with my patients and their families. Even though a person may be dying, they hold on strong to their sense of humour as it still feels good to laugh. To see the lighter side of even your own end of life is something that I have seen often. People still want to feel included in life and still want to have some fun. To be treated like a normal human being. My favourite thing after 22 years of medical practice is having a good laugh with my patients.
Last Friday, we had a great time joking around, whilst getting to know each other better. Pain and nausea had settled after a few days of hospice work. It was good to meet him properly for the first time, with his quick wit in full flight. I had trouble keeping up with him, a quip every other minute, followed by puns. Two proponents of Dad Jokes performing sit-down comedy, both riffing off each other’s comments, and enormously enjoying each other’s company. Each the perfect audience for the other. Our companions in the room were briefly forgotten, but we didn’t want them to feel lonely and started including them in our fun making. My team mates were included and then my comedy partner’s family. There were no taboo subjects as we launched into our roast of our room-mates.
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.
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.
It was three weeks before Christmas and she asked me to visit her in Wellington, preferably before Christmas. I was leaving for India the following week and no cheap flights meant it was not possible. I phoned her and told her I would visit when I returned from India.
Whilst in India, my Teacher got an email saying she had been admitted into hospice. I was unsure that I would get back in time. However, my Teacher was confident that it would be okay. At least I was in one of the holiest places and attending a prayer festival. I sponsored some group prayers for her as well as doing my personal prayers for her.
I met the Tibetan family that my friend sponsored. They were very grateful for her kindness and generosity and very sad that my friend was terminally ill. They requested me to take a beautiful woollen shawl back to New Zealand for her.
Within a few days of arriving home, I flew to Wellington to see her. She was out of hospice and back in her own home, being well cared for by one of her sons and her sister. Upon arrival, I was greeted by a much thinner version of my friend who was still quite mobile due to the loving care of her son and sister. I stayed two days with her.
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.
She was 80 years old, terminally ill and had loved gardening all her life. She filled her yard with beautiful flowers and an abundance of vegetables. She enjoyed the peace and satisfaction it gave her. Only using what was needed, she usually gave away the vegetables to family members or visitors.
When I told her I had a job as a part-time Backyard Garden Coordinator, she suggested that it might be nice to have a vegetable garden. When I reminded her of the promise I made to myself when I was 10, about never being a gardener when I grew up, she said to me, “darling things change, that was then and this is now.”
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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