Category Archives: #PallANZ

Palace of Care – Hold On

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Photo by Hu Chen on Unsplash

We’d been trying to admit her for weeks, but she had not been keen. We had her on the admission list for a whole week but she said that she had to sort out something for her children and couldn’t come in. I thought that it might be an excuse, as a lot of people are still scared of hospice. Most people have not had anything to do with hospice but they may have some pre-conceived idea of what hospice might be. Often this is inaccurate, and can generate a lot of fear.

It took some convincing by the hospital palliative care team before she would finally agree to coming in to hospice. She was still nervous but her favourite cousin had promised that she would go in with her. They had grown up together and they were best friends, but this had been taken to a completely different level once the cancer diagnosis had been made five months ago. Something was wrong as she had lost a lot of weight, without trying to. Life had been busy for many years with her five children, and her partner could not always be counted upon. It was her cousin who had attended all the Oncology appointments with her. Her cousin had been there for all the chemotherapy sessions. Having her cousin accompany her to hospice was comforting and if there was anything scary, she would be there for her.

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Bedside Lessons – 21 – Overcast Sky

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Photo by Malte Schmidt on Unsplash

100 years ago, when I was still a trainee registrar, I asked myself, “what were we going to do?” I was about to admit the kind of patient that hospital doctors would be eager to transfer to the local hospice. I’d done exactly that in my previous hospital role, but I was then working in the local hospice and would have to deal with the situation myself.

She’d been nauseated for two weeks in hospital. They had tried everything and nothing had worked. The last weeks had been rough for her, and even in that short amount of time she had lost weight. Her appetite was suppressed to nothingness, as she felt too sick to eat anything. The mere sight of food put her off completely.

After I finished the admission I felt miserable myself, some of her misery had rubbed off on me. Was this transference, or counter-transference? Something about the situation that she was in made me feel similar to what she was going through herself. What to do? One option was to stop all treatments and start all over again. That’s what I did.

The next day I found myself leaving the miserable lady until the end of the ward round. I did not want to catch her misery again in the fear that I would spread it throughout our inpatient unit. I was trying to avoid her as yesterday’s experience had made me feel worse for wear. She had made my heart sink and so I put her off for as long as I could. Things hadn’t really changed much, and I had another dose of misery before lunch time.

By day three I felt bad for being unsupportive of the patient and I promised to myself that I would try harder to connect with her and decided to see her earlier in the ward round. It wasn’t her fault that she was so miserable, it was the illness making her so, and we hadn’t been able to control her symptoms. Walking into her room I braced myself for the tidal wave of negativity. I held onto the door jamb as I entered her room, expecting to be sucked into the black hole of her misery.

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Palace of Care – No Surprises

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Photo by Raychan on Unsplash

Is it the medication making him drowsy, there’s been a big increase in the medications since yesterday, I want them cut back down again.

I’m really worried about your Dad. I don’t think it’s just the medications changes causing him to change. His pain and nausea have worsened a lot over the past three days. It’s a shame as he was doing so well the other day.

It’s not right, he should be getting better, not going backwards. You know he was an alcoholic, I’m worried that he’s become addicted to the pain killers. He hates being confused, that’s what he was like when he drank, he really doesn’t want to go there.

I don’t think that addiction is the problem here, his pain and nausea are worse, I think it’s the cancer causing this. If I decreased his medications now, he would become much more uncomfortable. I don’t want him to suffer.

What about his radiotherapy appointment, that will give him a boost right?

He’ll get the side effect right away, but the benefit might not occur for some weeks. I’m really not sure if he has weeks left to live. I’m worried that if he keeps on deteriorating at the same rate, that he might only have days left to live. We usually say if you are changing over months, you might have months left, same applies to weeks and days.

Really, you think he might only have days left?

Yeah, so I’m not sure that he will be well enough for radiotherapy. I know he wanted it and so do all of you, but I’m not sure that he will be well enough to make the appointment.

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Guest Post – Naomi’s Notes – Acceptance

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Photo by Markus Winkler on Unsplash

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.

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I think therefore I am? – Eat to Live vs. Live to Eat

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Photo by Edgar Castrejon on Unsplash

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.

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Palace of Care – Father and Son

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Photo by Vinicius “amnx” Amano on Unsplash

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.

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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 3

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Photo by Sebastian Staines on Unsplash

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.

My digital afterlife

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Our lives are increasingly digitised. I remember when my grandparents died, we went through their paper phone contact book to find out who we had to call. Now, with everything from banking to social media taking place online, things have changed.

How can we prepare for our #digitaldeath, after our bodies have died? What will your #digitalafterlife look like? #EOLC #pallanz

Here is a link to an animated video https://youtu.be/9UOe7otnRDw

Sonia

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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