Before I left for my holiday I turned on the automatic replies. Correspondents needed to know that I would be away on leave for a fortnight. Not a long break but enough to recharge and unwind. It takes at least a week to really start relaxing. In the past, I had been used to pushing hard and living on adrenaline that if I relaxed too deeply my immune system would crash and I’d catch a cold. These days I make sure I have something to do each day, a task of some sort that needs to be done. Nothing too stressful but something to keep me from relaxing completely. The tightrope balancing act of modern-day life. Rest but not too much too fast.
It had been a while since I’d been on leave. Also been a while since I’ve had to say goodbye to patients that I thought I wouldn’t ever see again. People who I thought would no longer be alive by the time I returned. Some of them I’d only just met in the last few weeks, others I had known for many months. Some of the recipients knew what I meant without me having to say anything more. Others had different ideas about their situation and believed they would still be alive to see in the New Year 2024, let alone the current one. I also said goodbye to the patients’ family members as well.
Goodbyes in palliative care are usually final. Most of the time you will never see the patient or their family members ever again. In fact, each interaction you have with people you deal with may be the very last time you see them. You have to make sure you don’t leave things in a bad way, as you may never get the chance to sort things out. You don’t want what may be one of the final interactions for the other human being to be a poor one.
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.
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.