Category Archives: #FOAMPal

Bedside Lessons – 9. Doctor to Doctor Part 1

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Photo by Usman Yousaf on Unsplash

Doctors are humans too and can become just as unwell as anyone else. When a doctor is assessing another doctor it can feel a bit strange. You might be assessing someone who has had the same training as you have, who may have worked as a doctor for much longer than you have yourself.

I’m usually calm in my approach to patients, well at least that’s what it looks like on the surface. I remember being particularly nervous one day when I was in my second year of being a doctor, as I had to admit one of the Professors that had taught me during medical school. One of the nicer guys who was always generous with his knowledge and time, always trying to nurture the next generations of doctors. He was not well and needed a complete work-up.

I started to see him and the usual procedure involved inserting an IV line and taking off some blood tests. I was about to stab one of Prof’s veins when the head of the department, a female professor, who had also been one of my teachers walked in and watched the proceedings intently. The needle went in, blood was taken, and then my patient Prof number one turned grey and looked like he was about to faint.

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I think therefore I am? – Life can literally be too short

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Photo by Heather Zabriskie on Unsplash

You’d think that we know this all too well working in palliative care/hospice but we are just as human as everyone else. We also get lost in the busyness of life in general. Rushing from one appointment to the other and having to switch roles as seamlessly as possible. I am no different to anyone else. I don’t have all the answers and am still searching for them myself but I want you to have a think about some questions I raise below.

Life is too short could be a stimulus to reflect on how you spend your time. Are you in a job that you actually enjoy? Do you feel like you are making a difference. We spend a lot of our time at work, 8 or more hours a day, maybe for 40+ hours a week, month after month, year after year. A big chunk of our lives is spent at work, and you may be spending more time with your workmates than you spend with your own loved ones, friends, and family. Are you happy at work or is there something else you’d rather do, somewhere else you want to be? Does it still satisfy you professionally? Are you finding yourself enjoying what you do or do you find yourself putting up with things? What would be your outlook on your job if you only had 10 years left to live? These are questions that we don’t ask ourselves, but are situations that my patients have found themselves in.

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Bedside Lessons – 8. Forequarter Amputation

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Photo by Fausto Marqués on Unsplash

He was found on the floor after having fallen down while walking back from his bathroom. A human arm should not have been able to bend at the odd angle that his arm was in. He was in terrible agony and an ambulance was called to take him to hospital.

I met him the next morning on the post-acute ward round. Overnight he had his fractured arm operated on, and screws and plates had been installed in order to fix the broken limb. He needed help with toileting and needed help with feeding. His other limb had been affected by cancer some years ago and had been removed along with his shoulder in an operation called forequarter amputation. It was terrible luck that his remaining arm had been badly injured.

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Bedside Lessons – 7. DNA

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Labels are easily applied to people but are not always appropriate. DNA – Did not attend is one of the commonest labels that can be given to patients and often no attempt to check their actual circumstances is actually made. DNA is a label that sticks to someone and can bias clinicians against patients without allowing them a chance to explain themselves.

Here’s a story about a patient that I met on a home visit many years ago which changed my thinking about the DNA label and labeling in general.

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Palace of Care – Unfinished Business

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Photo by Firmbee.com on Unsplash

I don’t feel well. I’m having trouble breathing. I feel so tired, but all I do is sleep. I’m feeling too weak to walk to the toilet, I almost fell over last night.

The nurses told me that you’ve had bad pain, but that you didn’t want to take pain relief.

I need to finish sorting out my legal affairs, I don’t want to leave too much for my friend to have to deal with.

Our social worker can help you with that stuff, she can talk to your friend. What else is bothering you? You look worried.

Doctor, I think I don’t have much time left, I feel so terrible, I don’t even have energy to talk to my sisters back home. Why do I feel so bad?

You’re getting worse, it’s the cancer, your body can’t handle it anymore. I think you are dying, and you might only have days left to live.

I thought so, I just need to sort my stuff out…

Then you’d be able to let go?

Yes, I don’t think I can hold on for much longer.

I think I can make you more comfortable, putting up with pain will use up your energy even faster, and make you more tired. Can I increase your pain relief a bit? It might make you less tired.

Okay, if you think it will help.

We’re going to get you through this, and even if you fall asleep we will continue to try to make you comfortable. We’re going to get you through this. This is our social worker, she can help you with your stuff.

Thank you doctor.

Please let us know if there is anything else we can help you with. I’ll see you later.

[Wave goodbye]

Palace of Care – Lockdown Locks and Roadblocks

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Photo by Mirza Babic on Unsplash

You really need a haircut.

Yeah, lockdown hair. I usually look different, like in my ID photo, I have a nose and a mouth under my mask.

So what do you want?

I’m here to find out how you are.

I can’t keep anything down, whatever I swallow comes back up. I’m too scared to eat anything. There’s something wrong with my poos too, haven’t been for four days, usually go twice a day. Last time it was black and sticky.

Do you have pain?

No, no pain but my tummy is getting bigger, sometimes it’s hard to breathe.

Hmm, listening to your tummy it’s very quiet on the left side, but loud on the right side. What do you think is going on?

I’m feeling worse, much more tired the last few days. What’s happening in my tummy?

We know that you have cancer in your tummy. It can act like speed bumps on a road, slowing down your gut traffic, that’s why your poos have slowed down. If there are enough speed bumps in your tummy they can act like a road block, then traffic can’t get through, and has to come back up, that’s why you’ve been vomiting. We can try to loosen up the roadblock with steroid medication, and we can try and push the traffic through with another medication, but…

But…Go on tell me, I need to know.

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I think therefore I am? – My Toe Con Dryer?

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Photo by Braňo on Unsplash

Here’s a short story that I have shared with children of various ages who are losing or have lost their mothers.

Prior to Medical School I completed a Biochemistry degree. I learnt all about the important biochemical reactions that sustain life as we know it. Some of the most important reactions require mitochondria, which are present in each and everyone of our cells.

Mitochondria can be thought of as the power plants of each cell. They allow energy to be released, keeping each cell, and each person alive. Without mitochondria we could not live at all.

Another special thing about Mitochondria is that they were likely an introduced species, likely to have developed on their own. Millions of years ago they struck up a relationship with the rest of the cell, and the successful partnership has continued on ever since.

An interesting thing about mitochondria is that they are only passed onto the next generation by the female of the species. Thus in each cell of our bodies there exists a tiny part of our mother, our mitochondria, which if not present, we could not be alive at all.

This started when the very first mother passed on her mitochondria to her children, and from her female children to their children, right until the current day.

No-one can ever take mum away from you. Even though mum may be dying, she will live on in every single cell of your body, along with your memories of her.

Bedside Lessons – 2b. What Daisy saw.

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Photo by Alejandro Ortiz on Unsplash

Hi everyone,

This was the result of a writing experiment in which I re-examined the case discussed in https://palliverse.com/2021/10/25/bedside-lessons-2-the-grandma/ from the point of view of a fictional 7 year old grand-daughter:

Grandma is my BFF by Daisy

My grandma taught me to read when I was only 4 years old.

She told me about alot of cool worlds.

We visit them in some of the games we play.

My grandma is my bestest friend fourever.

In the picture I drew of her she is wearing a cape.

That was when we played supa-heros together.

We had the funnest time ever.

I laughed so much I almost wet my pants.

You want to know a secret?

Grandma is my fave.

It was scary when Grandma got sick.
She had bad pain in her tummy, and was shivering then mum called 111.
I visited Grandma in hospital.
It’s a ginormous place.
The nurses were nice to me.
That doctor is a meanie.
She made mum and Grandma cry.
Something is wrong.
Was it me?

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I think therefore I am? – Clarification

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Photo by Jeremy Bezanger on Unsplash

The following are my own personal professional views and do not represent those of my employer or of Palliverse in general.

I’m not interested in debating the pros and cons of assisted dying, everyone is entitled to their own opinions. In Nov 2020, 82% of eligible voters voted in the referendum, 65% of the voters supported the End Of Life Choice Act 2019. Aotearoa/NZ clearly stated it’s opinion last year, and in two days’ time it will become law.

I do not want my patients to be caught in the middle of two warring ideologies.

I am not here to argue, I am here to listen to my patient, I am here to learn from them. They are the expert when it comes to what they are going through and their suffering is defined by them, not by me.

I think that we in Hospice/Palliative Care need to build a bridge and get over ourselves. Our focus should be on our patients, not on ourselves.

Please treat patients with respect, they weren’t born yesterday, but they might die tomorrow.

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Introducing Bedside Lessons – What isn’t done, isn’t done.

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Photo by noosha ghodsizad on Unsplash

It’s ironic that I am writing on a daily basis now when I barely paid attention in English classes and did not even do English in my last year at high school. I had a bad attitude back then and scoffed at having to read Hamlet, 1984 and Brave New World, choosing instead to read Alan Moore and Dave Gibbons’ Watchmen. Interesting that I can still remember all four books 31 years later.

The same applies to behavioural science lectures during medical school, I didn’t realise that upon graduation that a lot of the psycho-social-spiritual-cultural stuff covered in those lectures would be much more important in my day to day work life than the physical stuff. My training was in the traditional biomedical reductionist style. Medical school takes a young tree hungry for growth and knowledge and whittles it down to a sharp but prickly toothpick, with an ego the size of a man-made forest developed along the way.

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