I think therefore I am? – Blah Blah Blah

Posted on by
1
Photo by Pete Alexopoulos on Unsplash

A lot of importance is placed on the first thousand days of life and that is rightly so. The first three years of life are the formative years and can make all the difference in someone’s life. Some of the crucial attachments are formed and if things do not go well, there may be major setbacks which affect the rest of life in many ways.

What about the last thousand days of life? How a person lives in their final days needs to be considered. All of us who are born and live will one day die. Exactly when we do not know. People with life-limiting illnesses will live for much shorter periods than most people of similar ages. Illness has a detrimental effect on a person. Their physiological age no longer matches their chronological age. People with life-limiting illnesses can be thought of as frailer. Their organs are under strain from illness and may not function so well. They need the input of the whole multi-disciplinary team. Occupational Therapy and Physiotherapy input may become essential components in maintaining functional ability and independence.

The New Zealand Health Strategy was published in 2016 and it aspired for all New Zealanders to live well, stay well, and get well. No mention was made of dying well, despite all New Zealanders dying at some stage. Also in 2016 was published the Healthy Ageing Strategy aimed to have, “Older people live well, age well and have a respectful end of life in age-friendly communities.” This was followed in 2017 by the Palliative Care (In)Action Plan, which talked about planning a lot of planning but not much action.

Hey, let’s form some committees to plan for planning to take action. That will only take ten years or so, by that time a miracle would’ve happened and death would’ve been cured. Not quite, but the biggest health sector reforms in a generation started taking place on 1 July 2022, revealing a mystery to be solved. What will happen to us all? What opportunities for long-term palliative care partnerships may become available? What opportunities can we make for ourselves to ensure that palliative care/hospice remains relevant now and into the future? How can we shape the last thousand days of New Zealanders’ lives? Time to be creative and innovative. Time for some alchemy, time to transform talk into action. What do we want palliative care/hospice to be like in five years? Ten years? 25 years?

Hey, wait a minute, we haven’t sorted out the five-year survival of the New Zealand hospice sector yet. Maybe that needs to be the top priority.

Palace of Care – Phone a Friend

Posted on by
1
Photo by Dustin Belt on Unsplash

I was asked by a friend of our hospice to phone their cousin. This was because the cousin knew their favourite cousin had a long association with my hospice. The cousin’s friend of over five decades had always been unwell. They had inherited a genetic issue which led to lung damage from a young age, which led to chronic lung infection and scarring. A life lived in between many hospital admissions. The lungs had an unwelcome guest in the form of smelly bacteria, which had worsened already impaired breathing. As if there wasn’t enough on their plate along came cancer. The accumulation of all of the above resulted in worsened quality of life and increased struggles with activities of daily living. There was only so much one person could tolerate. A conversation about assisted dying was had with their family doctor as the law had allowed for this as a legal option for end-of-life care. The doctor assessed their patient as eligible. The second assessor had a different opinion. Request denied.

The patient was upset and didn’t know what to do. They phoned a friend to discuss this. The friend didn’t know what to do and phoned their favourite cousin. The cousin didn’t know what to do and phoned a doctor they knew at the hospice that would be willing to discuss assisted dying – still a taboo subject amongst many palliative care people in Aotearoa/New Zealand despite it becoming legal from November 2021.

I listened to the story and without full clinical details, I could only offer general advice for someone from outside of our catchment area. The person sounded unwell to me and might have less than six months left to live. They also sounded as if they needed more input from the local hospice service. The cousin said the hospice had sent a nice volunteer who was of the same ethnic origin to provide some company for the unwell friend. It was a nice thought but the hospice hadn’t checked a crucial detail. The volunteer’s English was limited, but they spoke the language of their ethnicity well. The friend looked similar to the volunteer in terms of ethnic features but had been born in New Zealand, only spoke English, and did not speak the ethnic language at all. Smiles and sign language could only go so far. It’s always better to ask rather than assume. Books and covers.

I suggested the cousin could encourage their friend to ask for more help from the local hospice as people in similar situations were being helped by hospices all around our country. I suggested that the patient could contact the assisted dying service to explain the outcome of the assessments made as the patient sounded as if they might fulfil the eligibility criteria. The cousin thanked me and said they would pass on my suggestions to their unwell friend. I felt it was a shame that their friend did not feel able to talk to their local hospice about their situation and assisted dying directly. I won’t make any assumptions about possible reasons.

I think therefore I am? – Homeostasis

Posted on by
Reply
Photo by Pickled Stardust on Unsplash

Humans are good at maintaining homeostasis and keeping things in balance. This includes the levels of various biochemicals in our bloodstream, blood pressure, body temperature, and sitting/standing/walking balance. The human body has many different organ systems with various functions and constant adjustments are made to keep us all in good running order.

When you are unwell the homeostasis may not work as well. You end up with fevers and may become dizzy and lose physical balance. Emotional balance can also be upset and uncomfortable feelings may be revealed. When things get really out of balance physical falls can occur. A high blood calcium level can be dangerous. Threatening both quantity of life, and quality of life.

The balancing act of life cannot be continued, the tight rope has become too steep to climb, the distance too far. Despite everyone’s best efforts, nothing can stop the fall. The situation’s gravity reminds us that what goes up must come down. How arrogant are we mere humans to think we could control Nature? State-of-the-art treatments may be offered but there aren’t many guarantees in this life. In the end, we all fall and cannot get up again. We can’t stop the fall, but maybe we can soften the impact of it with the care we provide. Let’s keep on trying.

Guest Post – PRR – WHO’S FREE?

Posted on by
Reply

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

Palace of Care – Sat Sri Akal

Posted on by
Reply
Photo by Sandy Millar on Unsplash

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.”

Guest Post -PRR – GIVE 100%

Posted on by
Reply


We are living in a very busy and competitive time. No matter whether we’re in Asia or in the West, we grow up with the idea that we have to work hard in order to “make it” – whatever this might be. Maybe we want to get a good job, have a happy family, a nice house, loyal friends and an interesting lifestyle.

We think that if we always give 100% of our strength then we can achieve all our goals. And you know what? I think that’s true. But maybe we have to look at this from a slightly different perspective.

Doing something 100% doesn’t necessarily mean being extreme. It doesn’t mean getting obsessed by something or thinking about it all the time while neglecting other things which are important in our life.

It means that in the very moment while focussing on something you really concentrate only on that. During your work you shouldn’t think too much about other things which are not related to it. And when you are not working you also shouldn’t think all the time about the work.

Rather while you are working, concentrate on your work and do it in the best way possible without being distracted. And when you are together with your family or friends focus on them and give them all your attention, care and love. Likewise when you have some free time for yourself let go of all the other things, enjoy and just relax.

In this way you can follow various activities without being distracted. Try to train your mind to be focussed. Be aware of your actions. Know what you are doing with your body, speech and mind. Ask yourself if you are really doing what you are supposed to do right now or if your mind is distracted by thinking of the last or the next year’s holidays.

In these times if you want to accomplish your goals without getting worried, stressed or crazy this seems to be one of the best methods: give 100% in every single moment.

PRR

I think therefore I am? – Injured Pride

Posted on by
Reply

Yikes, I injured my dominant hand’s middle finger at Brazilian Jiu Jitsu (BJJ) last night and I need to wear a finger splint for the next 6-8 weeks. Typing has become slightly more difficult. I will need to try some dictation software or apps and any suggestions will be most welcome. I made myself a splint from a used pen part:

The things I have taken for granted include good health and a functional body that does what you want it to. The next six to eight weeks may teach me a few lessons about living with a minor disability. In the paragraph before I typed the numbers 6 and 8. In this paragraph, I have typed the word forms. 8 keystrokes versus only two.

What will be affected?

Changing clothes.

Toileting techniques will have to be adjusted.

Showering.

Hair-washing, styling, drying.

Dishwashing and cooking will be attempted left-handed.

No BJJ – Groan, I am mildly addicted to it and usually go twice a week.

Hand – washing, writing, cleaning.

No high fives!

No finger snapping.

What opportunities may arise?

Getting into fights and arguments as I accidentally Flip the Bird as my right middle finger will be splinted in position.

No handshakes – Thank goodness for COVID!

I can compete in the 100mm Splint Race.

No one will tell me to pull finger anymore.

No more finger-push-ups.

I can try to break the world record for dirtiest finger.

I’ll save on right middle finger cleaning costs and help the environment at the same time.

I get to build up all the muscles on my left hand and arm:

Guest Post – PRR – QUANTITY DOESN’T EQUAL QUALITY

Posted on by
Reply

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

Palace of Care – Chronic

Posted on by
Reply
Photo by Stormseeker on Unsplash

The chronic illness had been there for twenty years and had disrupted every aspect of their life. It had caused a lot of pain. It was finally diagnosed only four years ago. Treatments were started but never made a significant difference. The effects of many long years of untreated illness were permanent. Somehow despite all of their travails sense of humour was maintained and they had even maintained gainful employment. Others would have been changed into photographic negative images of themselves, but not this person.

They prayed to their God for a way out of the seemingly never-ending suffering. Some years later the prayers were answered in the form of inoperable cancer which at the time of diagnosis had already spread throughout their body. Actual relief was the response when they were given the bad news. That’s how bad quality of life had been. They had considered accessing the Assisted Dying service but thought it would be against their religion. Their end was in sight, cancer would provide a natural escape from suffering, but it still felt far too slow…

I think therefore I am? – FAQs

Posted on by
Reply
Photo by Marek Studzinski on Unsplash

“You have to be special to work in Hospice/Palliative Care.”

“I’ve developed specialised skills over many years of training and practice.”

“You’re an angel.”

“No, I’m human just like you are. I have feelings and I am affected by what happens to the people I look after. I’ve learnt how to handle it, but it has taken a lot of work to be able to do so.”

“I don’t know how you do what you do. I couldn’t do it.”

“Well some days I can’t do it either, but those days are few and far between. Dealing with death and dying on a daily basis can be stressful. Self-care is essential as is team care. Wellbeing practices have become part of my daily routine.”

“Working in Hospice/Palliative Care must be so depressing.”

“No, it isn’t. Sure we see more than our fair share of tragic situations but we can still make a difference. How would it have been for the patient and their family if we hadn’t been there?”

“What do you enjoy most about your job?

“Seeing patients and their families. Having a laugh with them.”

“What’s the most important thing you can do for your patients?”

“Listen to them. Find out what they need. Find out what goals they are still trying to achieve, even at the end of life.”