A little bird told me that a great combination if you are wanting to improve your communication skills when it comes to palliative care situations is to check out the resources below.
The Serious Illness Conversation Guide can provide you guidance and structure for conversations.
Whilst Vital Talk courses and their app can help you to manage the emotional content of these important conversations.
My fitness tracker died on me a few months ago and since then the wear pattern on my shoes has slowed down. The reminders to do at least 250 steps each hour were a good reminder to stay active during the day. I have the luxury of working in a place with a garden surrounding it. A few times a day I can go out for a quick walk around the garden. One orbit is 500 steps, which would add to my daily step count. 10000 steps a day was more than achievable. The fitness tracker wasn’t mine, but one I had inherited from a family member, but I wore it out.
A few minutes of self-care interspersed within busy days. The simple act of walking in some nature. The sunlight on my face, the breezes through my hair. The sounds of the insects and birds doing their thing in the trees. The wind winds its way through many thousands of leaves. Not quite a forest to bathe in but in certain parts of the garden, you can stop under a tree and imagine that you are in much deeper woods. A momentary escape from the hustle and bustle of the workplace, I am briefly transported thousands of kilometres away. The fresh air is scented with the products of the plants themselves. It’s as if I am a time traveller, going back to the wellness retreat I attended three years ago, but I am not the same person anymore. Three years older and hopefully wiser.
I return to my office and the ward feeling refreshed. These micro-breaks throughout the day help to keep things calm.
People are always talking about being free and independent – kids want their own car and house so they are independent and free from their parents, people want their country to be independent and free from unwanted rulers. But nobody is free and independent.
Who really has control over themselves? We don’t have control over anything, not just external things, but even our own mind. We can’t control what feelings and thoughts we have from one moment to the next. And when these thoughts and feelings come, we are completely carried away by them and our life becomes like a roller coaster.
Modern technology makes everything faster, which in one way is good as we have access to more things, but in another way, the roller coaster of our emotions becomes much faster. For example, previously people exchanged letters by mail which took days or weeks, but now people exchange emails and text messages almost instantly.
We have no control and are totally dependent on conditions. For example, being in a relationship, if you talk to him or her every night and then one night you call and there is no answer, then you start to have all sorts of thoughts and emotions.
But if you have mindfulness and awareness of how you are dependent on causes and conditions then no matter what happens you won’t get completely lost or carried away.
PRR
When you do meditation, quality is more important than quantity.
People have a lot of ideas about how much practice one should do. Some Lamas might say you have to spend a particular amount of time doing certain pujas. If you can listen to them and practice accordingly that’s great! But sometimes it doesn’t work even if you do exactly what they say – if your mind doesn’t change at all even after a lot of practice something is going wrong.
For example you can do two hours of Tara practice each day. But if you are distracted during that time it might turn into a mere lip service or just another duty which is to be done on top of your other worldly responsibilities.
Some people who focus mainly on quantity might end up with daily sessions of discursive thoughts or “planning sessions” rather than doing meditation sessions. The mere amount of practice might turn into nothing more than fodder for a proud ego. In this way your practice might have a good quantity but not a good quality.
A good quality is like pure milk. Whether you have a glass or just a teaspoon of it, it remains pure milk. Discursive thoughts are like water. Good thoughts are like clean filtered water. Bad thoughts are like dirty polluted water. Now, whether you pour the clean or the dirty water into that milk, in both cases it’ll dilute the pure milk.
I’m not saying that you should let go of your practice! Don’t use this as an excuse in order to minimize or escape from your daily meditation sessions. A regular practice is very important. It’ll gradually train and transform you. But you should always examine whether you are really focused on the practice or simply counting hours, minutes or mantras without even trying to tame your mind.
Don’t fool yourself by thinking that you’re a great practitioner because of quantity. Likewise don’t fool yourself by thinking that you’re a great practitioner because of quality. No matter what you say to other people about your practice – if you are insincere you won’t fool anyone but yourself.
What matters most is that you discipline yourself. Be your own boss. Take responsibility – for your life, your actions and your practice. Don’t depend on others or particular situations to make things happen. Otherwise nothing will ever happen. As I already said in one of my previous posts: Just do it!
When you practice try to make the time you spend really meaningful, no matter how long or short it may be. Develop a positive attitude towards it so that you can generate a natural habit and sincere wish to practice regularly.
This is how I try to approach my daily life and practice. Since it works quite well for me I thought of sharing it with you. However, if what I am saying is not helpful for you then better just do what you consider to be best for you.
As I said: take responsibility for yourself. Things don’t just happen. You have to make them happen.
PRR
It’s important to be able to switch off and take a rest. We are human beings and are not robots and though we need time to recharge our batteries. There is only so much time we can work before we need to take a break.
We cannot be on duty 24 hours a day as we need some time out from the grind. A job is a job, it can’t be your life, no matter how much you like or love your job. Are you in your job for the right reasons? Who are you doing your job for? Is it for the money or the prestige? For fame and glory?
What impact do you want to have on this world we all live in? What is your definition of success? What will it mean for you to have achieved your goals? What sort of difference do you want to make on other people?
On your days off try not to check your emails. Leave your calendar alone. They will still be there after your short break. They won’t be pining after you, and probably could do with some time away from you as well. There will always be work to fill up any spaces in your day. Nature abhors a vacuum and will find something to fill in your time.
As children we can’t stand being bored, every waking minute needs to be filled with 60 seconds of stimulation. As an adult I long to have a chance to be bored. Each minute is filled with 120 seconds of tasks to be done. There are too many interesting things to do. Too many distractions in life. Becoming bored will allow for some creativity to sneak back into your life.
Allow yourself some down time. Who knows what will pop up? You are not a robot, and even robots need maintenance time and care to run efficiently. Take it easy on yourself. Show yourself some self-care and self-compassion. You deserve it.
I often meet people who cannot forgive. Even after many years they keep telling the same old stories about how they have been treated unjustly or how they have been cheated, deceived, belittled, or hurt.
The reasons for resentment can be many, with feelings of disappointment, anger, and even hatred quite common. We are not perfect, so how can we expect others and our relationships with them to be perfect. That’s how life is, we all make mistakes. That’s how we learn and grow.
Sometimes with the best intentions, we make situations worse – we want to help someone but instead increase their suffering. Often we lack the wisdom to really see what actions are required or to understand when to act and when not to.
When you see your own limitations and faults, then it is easier to understand and accept those of others. You can then forgive and let go.
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In Palliative Care practice I often have emotionally loaded conversations. Tough talks about death and dying are commonplace. Emotions may flow in a raw state and tears may be involved. Sometimes you are confirming people’s greatest fears. They will not be recovering, they will become more unwell, and they will die. The emotional hit can be hard and the energy is felt by the recipient as well as the provider of the information.
Human emotions can be messy and the levels of distress can be high. When in the clinical moment I have to hold it all together, to stay calm as I guide them through the rough waters. I allow the emotions to flow, to be felt as they cannot be denied. Preparing someone for their imminent death can be some of the toughest work I do and some of the most important work I do. I don’t want anyone to have any surprises, they need to know what they are dealing with. The information will be shared in a kind and gentle fashion, but some ideas and concepts hurt when they are heard. The treatment of someone’s existential distress is beyond the effects of any of the medications I prescribe.
After conversations with high emotional stakes, I will call for a break. I will remove myself and my team from the patient room and will leave the inpatient unit itself. We walk upstairs and have a drink in the staff room. We remove ourselves from the fray, even if it is for five minutes. A micro-break is had. Our bodies and minds are taken away from the physical environment where heightened emotions were experienced. We nourish our bodies with some food and drink and take some time out. If possible, we also go out onto the deck to have some fresh air and sunshine.
Soon enough we will be back downstairs to deal with the next case. The short break allows us to be present for the next conversation with our next patient.
Here’s something you could try doing that my writing in community friend Martha shared with me this week:
An assignment that literally changed my students’ lives. Extra credit (optional, and adds points to overall score). Make a list of 50 things you are grateful for in your life. Must use following format:
I am grateful for _________________ because __________________________.
One pt. for each line. Must complete 50. 49 won’t do. Must fill BOTH blanks for each line. You will get 50 points added to your grade.
Example: I am grateful for my grandma, because she makes me breakfast every morning.
I could tell you so many stories about this assignment! Not everyone chooses to do it. And sadly, not everyone is able to think of 50. If not being able to complete the assignment is perceived by the student as a problem, I see that as a good thing. I love coaching them to see things in their life to be grateful for. I can tell when a student has stretched and really starts to “get it.”
At the time I was in Phoenix, AZ, and I often got this response (one of my favorites) included in the list.
I’m grateful for my shoes, because without them I couldn’t walk anywhere when the sidewalk is so hot.
The last question of the assignment: Now that you’ve completed your list, look inside yourself. How do you feel? Has anything shifted?
Once in a while I would get a “no.” But of the 70% who actually answered the last question, almost everyone said that they experienced a shift. Some said they felt happier or more positive, while others said they realized they had so many good things in their lives that they hadn’t actually realized.
I started writing this post two years ago, and I tried to complete it this time last year but I wasn’t able to. I have finally completed it today, and it serves as a sneak preview chapter for my upcoming book Bedside Lessons which will be available for purchase on Amazon Kindle on 09 June 2022.
Death Jumps The Fence – I miss my mum
Every Friday I usually wear a fish neck-tie and chips socks, this is in honour of my parents who ran their fish and chip shop for 35 years. Friday was always the busiest day thanks to ancient papal decree. Mum loved to work in the shop and chatted to generations of families who were regular customers. Mum’s eyesight was destroyed by an autoimmune condition called Uveitis. This stopped her from driving her car that she had owned since it was brand new. A red 1982 Toyota Corona – Popularity has decreased since 2020. Not being able to drive limited Mum’s independence. Her partial blindness in one eye, and near total blindness in the other didn’t stop her working. Somehow she would still cross one of my hometown Napier’s busiest street to walk to the shop. She loved serving her customers and always had a friendly smile for them. Apart from rheumatoid arthritis and a blood disorder, Mum’s health was good until her final illness.
It all started early one morning, when severe back pain woke Mum up. She was rushed to hospital and couldn’t move her left leg. The initial differential diagnosis was of a stroke but the head scan did not reveal any brain issues. Further tests discovered a blood clot which had blocked the spinal artery which supplied the area of spinal cord controlling the left leg. Mum had been troubled by a blood disorder for the previous five years. This led to her blood being thicker than usual, which may have caused the clot formation. Blood thinning medication was started. Other tests discovered a suspicious mass lesion in her chest. A biopsy was requested.
Whilst awaiting the biopsy Mum was reviewed by a lung doctor who bluntly told her that she had cancer, and that she would need to have intensive treatments. These would need to be done at the regional cancer therapy centre, two hours drive away. This sent my Mum, who was always a bit anxious, into a tailspin. She stopped eating, couldn’t sleep, and was inconsolable.
Mum had a good memory throughout her life, but in the months prior to this illness she had started having short term memory loss. Looking back at this her illness had likely taken its toll on her memory. Two days after the bluntly delivered unconfirmed diagnosis Mum had forgotten what had been said, and was able to continue her recuperation. She knew that a biopsy had been arranged but could not remember what for. The prospect of it terrified her.
I flew back to Napier on a Friday morning to help Mum get through her biopsy. She was scared and needed her hand held. The radiology team who were performing the biopsy ushered me in the room, and I gently told Mum to take deep breaths. I explained to her in Mandarin Chinese, “There will be some pain from an injection. Then your skin will go numb. They’re about to put in another needle. It shouldn’t hurt, let me know if it does. There will be some pressure but it shouldn’t hurt.”
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It was my mother’s birthday. It was a cold, bleak winter’s day. I had put on a nice warm woolen skirt that my friend had given me which belonged to her mother. It was a bit big on the waist but was okay. I wore it to work. After school I rushed to buy some flowers to take to the cemetery before it closed.
When I arrived I was the only person there, and I quickly arranged the flowers on my parents’ grave. I stood back to admire the flowers and my thoughts turned toward my precious mother. It was starting to get dark, I felt sad as I walked back to my car. I remembered happier times on my mother’s birthday.
Suddenly I felt very cold, I thought to myself the temperature had plummeted. Then I looked down and saw that actually it was my skirt that had fallen down and I was standing in the cemetery in just my stockings with my skirt on the ground.
I started to laugh and laugh and laugh. Then I suddenly realised if anyone saw me in my stockings laughing so loud in the cemetery they would think I was having an ‘episode’ so I quickly put my skirt on and walked slowly to my car.
Then I noticed the security cameras. I raised my handbag to my face to save myself some embarrassment and walked faster to the car. I smiled to myself as I drove home as I remembered what my mother had said to me when I was young ….”Always wear a petticoat.”
palliverse.com 