Category Archives: Ideas

Advance Care Planning International 2022 Webinar Series – “Advance care planning – what’s in the pill?”

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Photo by Christin Hume on Unsplash

Following on from a successful digital conference in 2021, the Advance Care Planning International (ACP-i) Committee is excited to announce a series of webinars in 2022, focusing on how different healthcare systems are implementing advance care planning.

Each of these webinars will put a spotlight on one country, with invited speakers giving presentations which will investigate the different components and ingredients that go into successful ACP programs in their country or region. In other words, exploring “what’s in the ACP pill?” Webinars will be one hour in duration, with one or two expert presenters and time for panel discussion and Q&A.

The first of these webinars will go down under, with presentations from Australia (Tuesday March 22nd 10pm-11pm AEDT) and Aotearoa/New Zealand (Wednesday March 23rd 10am-11am). The webinars are free to attend, but registration is required through the ACP-i website.

The Australian webinar on Tuesday March 22nd will feature Jill Mann (Barwon Health ACP Program Manager) and Dr Leyton Miller (Queensland Health Palliative Care Consultant), with the session facilitated by Dr Craig Sinclair (University of New South Wales). For more details and to register, visit https://www.acp-i.org/

In a stroke of good planning (or was that good fortune?), the Australian webinar will also occur during National Advance Care Planning Week 2022. Advance Care Planning Australia coordinates this annual awareness-raising week, with a series of events being held around Australia, in person and online. The key message is ‘Your Choice. Now and Always.’ To find out more about events in your area, visit the Advance Care Planning Australia website.

As part of 2022 National Advance Care Planning Week, we hope you can attend and participate in this global conversation.

Palace of Care – My Favourite Thing

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Photo by Lisa H on Unsplash

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.

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Palace of Care – Welcome to Hospice – Part 2

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Photo by Brittani Burns on Unsplash

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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Photo by Belinda Fewings on Unsplash

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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Guest Post – Naomi’s Notes – Change

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Photo by Markus Spiske on Unsplash

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.” 

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Bedside Lessons – 20 – Crossing the Line – Part 1

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Photo by Max Böhme on Unsplash

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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Photo by laze.life on Unsplash

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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Photo by Christina Deravedisian on Unsplash

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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Photo by Timothy Eberly on Unsplash

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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