Palace of Care – What She Said at Lunch

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Life over the past two years had become chaotic and uncertain, but she was certain that the gathered guests were there for a good cause. She thanked the crowd for spending their time at the hospice fundraising lunch. In New Zealand there are over 27000 registered charities and on this day hundreds of people had chosen to be there to raise money for the hospice. She thanked the sponsors and donors for their generous gifts and support. She told them that hospice couldn’t do what they do without their help.

She didn’t know what hospice was about until three years after her mother’s death. She cradled her mother in her arms as she became heavier and heavier, and as she took her last breaths. Although she was flooded with deep sadness, relief was the dominant feeling. Relief from her mother not suffering any longer. The night before her mother died she decided to chase her dream to become an Olympian. On arrival at the hospice they could feel the care and love surrounding them. When her mother was transferred to the hospice she was able to sleep in a La-Z-Boy instead of the hard-tiled floor of the hospital.

Yesterday morning she thought she would not survive long enough to speak at the hospice fundraising event this afternoon. She had to bring her oxygen bottle to be able to attend. She shared with the audience her own experiences of hospice, and how they had helped her make life more bearable. She talked about the friends she had made at the hospice’s living well centre. There was one friend in particular who she missed the most. The final contact they had with each other was when her friend was in the hospital. The hospice group of friends had sent their friend best wishes via a group photo, which was much appreciated. Unfortunately, their friend died the next day. A reminder of how precarious life is when you are dying.

Palace of Care – Sat Sri Akal

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I prepared to see our patient and their spouse. They had been doing well until the past week. Then the weakness and fatigue worsened. They didn’t have the strength to leave the bed. Their spouse looked after them well. Their children were parents too. They were proud of their grandchildren. A close family but COVID-enforced separation had meant they had only seen one of their children once in two years. The same two years that cancer had taken over.

The spouse was worried about sedation from medications. The patient was reported to be in a lot of pain and could use more medication. Breathing was laboured. The patient had not spoken clearly in the 48 hours preceding the admission. As soon as I entered the room I noted the distress on the patient’s face, mirrored by the look of concern worn by their spouse. I needed to establish rapport quickly, as the suffering needed to be attended to urgently. I recognised the traditional turban and greeted them with, “Sat Sri Akal.” A look of surprised appreciation crossed over the spouse’s face. The patient stared blankly at the ceiling in a confused manner.

“They’ve been uncomfortable overnight with pain. I need to do something about it. I’m worried that it isn’t safe to swallow anymore. This is what happens at the end of life when someone is dying.”

“Can I feed them, they haven’t eaten since yesterday.”

“When someone is very unwell they can’t handle the food. They can’t swallow safely and it might end up in the lungs. It might cause vomiting or diarrhoea. I don’t want to make the situation worse or increase the suffering. We need to give medications by injections, under the skin.”

“Subcutaneous?”

“Yes, that’s right. It will be the safest way to give medications, to make sure they go where they are needed.”

“Okay, how much time do we have left?”

“I’m sorry, your spouse is so unwell, they might only have hours to days left to live. They could die at any time. I’m sorry.”

“No, no need to be sorry. It is part of life, it is something that we have to face at some stage.”

“We will do our best to make them comfortable, no matter how much time is left, we will keep on trying. We want to calm down the pain, calm down the breathing, calm down nausea and distress”

“Thank you, doctor.”

“How long have you been together?”

“44 years.”

“I’m going to change the medications now. Please let us know if you or your spouse need anything. Take care.”

Palace of Care – A Reluctant Patient

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I first met our reluctant patient in the outpatient clinic with his girlfriend. It had taken a number of phone calls before he would come in for assessment. He was scared of hospice and had resisted his Oncologist referring him to us. He didn’t know what we were about and what he didn’t know frightened him.

He had been unwell with cancer for over a year with severe pain making him unable to sit or lie down for more than an hour at a time. Sleep was difficult for him and he was woken up several times a night by burning pain that spread down his right leg. He wasn’t keen on any changes in medication, and it took much negotiation for him to allow us to increase the doses of the pain relief agents he was already taking. He didn’t want to consider anything new, just yet. As his pain was so severe I offered to admit him into the inpatient unit but he wanted to stay at home.

Over the next month, his pain did improve but any relief would only last for a few days at best. We again offered to admit him for pain control but he still wasn’t ready. Some weeks later the pain had worsened bringing tears to his eyes. His mother and girlfriend were exhausted and felt helpless as they couldn’t help reduce hisWith encouragement from his mother and girlfriend he agreed to be admitted.

We started him on a different opioid that afternoon. The next morning he was full of smiles. He told us he was pain-free for the first time in two years. He stayed a few more days as we helped him with other issues, and then he went home. As well as good pain control we had built a trusting relationship that would help during his next admissions.

I think therefore I am? – Collegial Jealousy

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One of our most trusted employees doesn’t mind doing night shifts. He is happy to do casual shifts with little prior notice. He is adept at looking after all sorts of different people. He can be counted on to be there, although he can be fickle at times. He picks and chooses who he will spend time with. One day it might be in the older lady’s room, another night he might wander off and into the young man’s room. He doesn’t even knock, and somehow can sneak into the rooms without anyone noticing.

One of our patients thought that our staff member was channelling the essence of their late mother. Every time our staff mate visited the patient in their moments of need, it felt like his mother coming in to check on him, from the next plane of existence. This provided comfort to both patient and family.

Our valued employee had a new assignment the other week. Our patient was the mother who was not long for the world. Our staff member took especially good care of her, and also her daughter as well. Having him in the room provided them good continuity of care, as otherwise there was a new set of nurses every shift, and the doctors would change around every few days. They enjoyed his visits and his words of wisdom lightened the mood and their hearts.

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Guest Post – Naomi’s Notes – Precious

Part 1

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At school two little six year olds had an argument.  They were both very upset when I called them over to talk to me.

I asked the first one what the problem was.

Pointing at the other girl with a quivering finger she said, amongst sobs, “she called me a F F F FAT BANANA. Why are you laughing?”

“Well,” I said, “are you a banana?”

“No.”

“Are you fat?”

“No.”

“Is it true?”

“No?”

Softly I said to her, “so darling if it were true it would be serious, but it’s not true so it’s funny isn’t it?”

I asked the other girl, “why did you say that?”

“I wanted her to be my friend but she didn’t want to,  so I called her a FAT BANANA…  Naomi,  I really love bananas.”

I smiled and said to her, “darling if you want someone to be your friend, that’s not the way to do it. First you  have to  help them if they need help, be kind to them and laugh at their jokes.   Then they will want to be your friend because they can see that you are a kind and caring  person.” 

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Bedside Lessons – 9. Doctor to Doctor Part 1

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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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Bedside Lessons – 2b. What Daisy saw.

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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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Weekend read/listen

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Palliverse founder Dr James Jap has made some recent appearances in two non-palliative care websites. James was interviewed by NZ actress/writer Michelle Langstone writing for NZ’s The Spinoff.

After reading this article Australian writer Aimee Chan asked James to be interviewed on her Kids Pod podcast.

Click on the following hyperlinks if you fancy a read or a quick listen:

Dr James Jap on a life centred around death

Kids Pod Episode 127

Keep washing those hands and social distancing.

Take care and have a great weekend!

University of Melbourne survey for frontline health professionals on the impact of COVID

STUDY PURPOSE

This survey explores the important social, occupational and mental health effects experienced by frontline health workers during the COVID-19 pandemic and beyond. As the pandemic has changed our social and work environments in many different ways, we want to hear the experiences of both frontline health workers who have and have not worked directly with people with COVID-19.

We will examine factors that promote good mental health and wellbeing, as well as risk factors for poorer mental health. Your input will inform recommendations to healthcare organisations and other professional bodies.

https://covid-19-frontline.com.au/

WE WANT YOU

This study focuses on the experiences of medical, nursing, allied health, clinical scientists/physiologists/technicians, healthcare students and clerical staff who are working in the following frontline areas:

  • Anaesthetics/Peri-operative Care
  • Emergency Medicine
  • General Medicine
  • Hospital Aged Care
  • Infectious Disease
  • Intensive Care
  • Infectious Disease
  • Palliative Care
  • Paramedicine
  • Primary Care
  • Respiratory Medicine

People working in other frontline health areas (such as medical or surgical areas) are also welcome to take part.

You do not need to have worked directly with people with COVID-19 to participate, as we would like to hear from all frontline health workers.

I think therefore I am? – Online wellbeing resources from the NZ Mental Health Foundation

5ways

Wellbeing resources for frontline healthcare workers are available from the NZ Mental Health Foundation’s website – this easy to navigate website includes lots of useful tips for this difficult time we all find ourselves in. As well as links to websites, Frequently Asked Questions, and downloadable resources.

allright

On a similar theme is their well-designed All Right? website which also includes links to their getting through together campaign designed with COVID-19 in mind. Plenty of good wellbeing ideas for all age groups are contained in this vibrant, colourful and energetic looking website. Well done NZ Mental Health Foundation!

Both of these websites are well worth a deeper exploration and may be helpful to yourself and others in your bubbles.

Stay safe and take care.