Category Archives: #PallANZ

Guest Post – Naomi’s Notes – Making Friends

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Photo by Jason Pofahl on Unsplash

The sound of the skipping rope whirring as it hit the ground meant their father was up.  He used to skip every day before he went to work.  

He taught his children resilience, to never give up when learning something new no matter how difficult it was. “You just gotta make friends with it”, he used to say.  

He loved his children and would try and spoil them when he could.   

He fancied himself as a mechanic and would often diagnose the car trouble as needing new spark plugs.  When asked if he had fixed the car he nodded and said  it didn’t need the key to start it, you just had to stand at the front step and clap your hands and it would come.

He was of that generation where you didn’t tell your kids you loved them but you showed them.  When his children told him they loved him it was met by an embarrassed silence.

The removal of his gall bladder heralded the start of his decline. He became increasingly ill and grumpy and as the days moved on he became less communicative.  He was always very direct in his communication. When his children spoke to him on the phone he never said hello or goodbye. He said their name and at the end just hung up.

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I think therefore I am? – Final Human(?) Interaction

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Photo by Lewis Roberts on Unsplash

With palliative care/hospice patients and their fragile health status, there is a chance that every time you see them might be the last time they ever have a meaningful connection with a fellow human being. Things can change in an instant, people can lose consciousness or clarity. Keeping this in mind, try to make each interaction as pleasant an encounter as you can for the both of you. The following tells of an unpleasant distressing encounter.

I was asked to see an unwell Oncology patient, who was in a lot of pain, and possibly about to die. There was a language barrier in that he did not speak English, thus an interpreter was organised to facilitate communication. That was the idea anyway, what actually happened was different.

The man in bed looked fragile, he had trouble communicating with his family, as he was lapsing in and out of consciousness. The interpreter arrived, a young man, who looked nervous. He stood at the end of the bed and didn’t greet the patient or his family members. The patient was being prepared for a scan and might need to head downstairs at a moment’s notice, so time was of the essence.

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Guest Post – Naomi’s Notes – Cushion

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Photo by Wonderlane on Unsplash

They met at a seven-year meditation/philosophy course, which required participants to travel to India each year for the 1st week in April for instruction. It was taught by  H E Tai Situ Rinpoche one of the great Meditation Masters.

The seating was cushioning on the floor, he sat in front of her.  He was from Germany with limited English and she was from New Zealand (NZ) with limited German but they were able to communicate.   They formed a group with the Spanish man that sat next to him and the Taiwanese woman that sat next to her.  The group exchanged email addresses and from time to time corresponded. When in India they would all have breakfast together.

After year three of the course, he wrote to say he had to drop out of the course as his 88-year-old mother was sick and he needed to care for her.  He wrote about his newly acquired knowledge in gynaecology, breast cancer, podiatry, and dentistry gained from having accompanied his mother to all of her appointments.

She wrote back and gave him some moral support.   She also sent a gift from the NZ sheep, woollen socks for both his mother and him. 

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I think therefore I am? – We told you so

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Photo by Alex Shute on Unsplash

Too young to be dying , only 32, with two toddlers 3 and 1 years old, she hadn’t even been a smoker. She had only had back pain, and on investigation last year, they found that she had metastatic lung cancer.

She came in with terrible pain, hadn’t been able to sleep for most of the week. Her partner, the father of the children, looked just as exhausted. Looking after her and the two tiny children. A tragic situation.

Pain difficult to control, breathing in a distressed fashion. She could barely leave her bed in the last two days.

Usual rule of thumb applied, if changing over months, months left to live, weeks – weeks, days-days, hours-hours.

Over the past four days, a change noted each single day. We estimated that she only had days to short weeks left to live.

We knew that she was supposed to go to Oncology, to have chemotherapy, but we thought she was too unwell.

We rang the Oncologist to discuss this, that we thought that she was dying, with only days to weeks left to live. We recommended that she not have chemotherapy, as we were concerned it would cause her more harm, than any potential benefit.

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Palace of Care – The Ties That Bind

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Covid summer time and I’ve been wearing boring grey coloured scrubs for months now. As it became hotter I must admit that it has been good to not have to wear neckties – my usual trademark item.

My patients and their families usually enjoy them, so I will continue wearing them. They can be a good icebreaker, in that a doctor who wears cartoon ties probably isn’t so far up himself, chances are he’s approachable.

One Friday whilst wearing a rainbow trout on my neck I had asked my patient what tie she wanted me to wear on Monday. She said to wear a favourite one, and so I would.

I walked in and noticed that we had something in common. This had not been arranged and had happened purely by chance. Turquoise was the colour of my tie and the colour of her night dress, exactly the same colour.

Hey great minds think alike.

Yeah we both have great taste in colour.

I love Winnie the Pooh.

Heh, I’m the only doctor who doesn’t mind a bit of Pooh on his tie.

Haha, you know we have something else in common too.

Oh really, what’s that?

She took the turquoise short sleeve off her left shoulder revealing a Winnie the Pooh tattoo.

SNAP.

I was uncharacteristically speechless for a few seconds. Wow, synchronicity.

Tie requests were entertained over the next week, but then she became too unwell to choose.

When she was actively dying and unable to talk her family members presented me with something that she had wanted me to have.

Thank you, that’s really nice, I promise that I will wear it well.

Since then, on alternate Fridays, I wear a purple tuna fish around my neck.

3/80 of the ties in my collection

Palace of Care – Best Laid Plans

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Photo by Pedro Miranda on Unsplash

Advance Care Planning (ACP) is recommended for everyone. It allows people to convey what is important to them. It can guide loved ones and health professionals as to what your wishes are in the case of you becoming incapable of expressing yourself. Such a situation is possible for anyone and thus it is recommended to be completed whilst you are well. Although it can be hard to imagine how you would feel or act in the event of severe illness or disability. ACP allows people to take some control of the end of their lives. This is what I want, this is want I don’t want. This is who I want around me. This is how I define what is quality of life for me. This is where I draw the line. It can be a confronting and difficult exercise to complete with your loved ones but it maybe a crucial method to communicate what you really want.

My patient had been diagnosed with MND (Motor Neurone Disease) over a year ago, and after attending the second clinic appointment they had introduced him to ACP. He read through the booklet with his wife, and it appealed to his organised nature. He always had a monthly, yearly and five-yearly plan in action. The doctor had said that most people would die of MND 18 months after diagnosis. This can mean time is running out, and this is not aided by diagnostic delay. All other illness have to be excluded before the diagnosis of MND is confirmed, for most people it is still a death sentence.

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Palace of Care – Second Languages Part 2

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Photo by Jaddy Liu on Unsplash

I had been on call for the hospital when the little old Chinese man had first presented to hospital. They had discussed his situation, a large stomach cancer which kept on bleeding, and that his Hb level was only 41. My opinion was that he was dying from recurrent bleeding that could not be stopped. My advice was that the hospital team have a discussion with the patient and family about the fact that his bleeding would be a life-ending event, that further transfusions would not be able to keep up with the amount of bleeding that was happening.

Some of my advice was taken, but not everything. It was as if the hospital doctors had spoken to me in a second language, one that didn’t lead to mutual understanding. They did end up having a conversation with the patient and his daughter about no further transfusions, but this was after transfusing one more unit of blood. The hospital doctor could speak Mandarin with the patient and family. He told them that the last unit of blood was an, “especially strong unit of blood, and would give him an extra boost.” Following this final transfusion the patient was sent across to the hospice.

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Palace of Care – Second Languages Part 1

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Photo by Tatiana Rodriguez 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 became more unwell.

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 him and his wife. 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 – I’ve got a question Doc

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Photo by Artur Łuczka on Unsplash

I need to ask you a question about Dad.

Sure, go for it.

You know that Dad missed my wedding last weekend because he was too unwell?

Yeah.

Well, we had planned to have our honeymoon right after the wedding. We’re supposed to take off tomorrow.

How long will you be away for?

Five days, we are due back Wednesday. I’m not sure what to do.

I’m worried about your Dad, and I’m unsure if he will still be alive on Wednesday.

I can postpone my honeymoon, my wife and I can go at some other time, but this is my last chance to be with my Dad.

You’ve made the right choice, we’re going to get your Dad through this and the rest of your family too.

Thanks Doc.

Hey that’s what we’re here for, please take care.

I think therefore I am? – Butterfly visitors

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Photo by Marian Brandt on Unsplash
  1. Reincarnation was one of the topics of conversation in the first room this morning. Our patient was a believer and had told his wife that she would come back as a dog. Unfortunately one of their daughters had died only a few years ago. It is always difficult for parents to deal with, as it goes against nature’s order to have a child die before a parent. One of the tragedies in life that elderly people would like to avoid if at all possible. Their daughter had died but had left her traces everywhere.

She had always loved butterflies, and had grown lots of swan plants in order to provide food for her favourite Monarch butterflies. She had a keen eye for their caterpillars and could see them from a distance, their yellow, black and white lines indicating their presence. She especially loved the pupae/cocoons that would form as the caterpillars went through the biggest changes in their lives, metamorphosis. Coming out the other side of the process transformed, with a new outlook on life and the ability to fly. Looking so different in colour scheme and features. She had always loved to have butterflies around. In some cultures it is believed that butterflies are visiting dead friends and family members who have come to see you from the other side of the grave. This is a comforting thing to have your ancestors come to see how you are.


Our patient had been steadily deteriorating over the past week, and he and the family had derived some comfort in being visited by Monarch butterflies. It was thought that their late daughter/sister was visiting their father as he entered his final cocoon state, just before dying.
I told them that when people die in our hospice we would affix a butterfly to the door.

I have often drawn cocoons on our patient list board to indicate that people are undergoing the final transformation in their life, the dying process. One in which everything starts to wind down, the heart, lungs and other organ functions change. A person becomes sleepier, and less clear in their mind, Nature or a higher power’s way of protecting the dying person from the full experience of dying.

“Please keep on talking to him, he can hear you, but might not be able to respond to you.”
Family members were considering leaving for home to come back again soon, but I advised that he could die at anytime, and that traveling under lockdown restrictions was not as easy as usual. Probably better to hang around and support each other for a few more days.

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