She called him Grelly when she was young because she couldn’t say Grandad.
He used to pick her up every day from Kindy. Always the same routine when she got to her Mama’s house. She would sit next to Grelly and he would let her dunk her biscuits into his cup of tea. He didn’t mind if her biscuit fell in.
She entertained them by reciting the poems and songs she had learned. She loved it when they joined in and sang with her. Grelly would let her be the boss of the TV remote and watch her programmes with her. She didn’t mind that he didn’t know the words to Spongebob Squarepants because he made up for it by dancing with her when Bananas in Pyjamas came on. When she was sick he would phone her and tell her he and Mama were missing her.
When he became sick, she would rush in to see to see him. She would kiss them both and show them her drawings and tell him what she had done at Kindy.
She was a solicitor used to dealing with other people’s problems and separating the emotion from the facts. But today she looked tired, worn out, and close to tears.
“Noticed your not your usual self what’s the matter”? I asked.
“I’m caring for my dying mother at home and have been doing it for the last two months. I need to get home as quick as I can”.
“Do you have anyone helping you”? I inquired
“Sometimes my sister helps but she has three kids. Mostly it’s just me and mum, I had to move in with her temporarily to take care of her because she couldn’t manage on her own. I’m not sure if I can manage. I sleep in the armchair next to the bed”.
“Would it help if I sat with her while you do your work at home”?
A smile fleetingly replaced the stress on her face. ‘Here’s the address she said and my number if you get lost”.
“Ask your mum if I can come and see her, phone me if she says yes, no problem if she says no”.
Later that evening she phoned confirming it was okay.
As the rest of the passengers vacated the plane and went through in my head how to reassemble the collapsible stretcher that I would use to carry him off the plane. My patient had limited mobility and would not be able to help much in the transfer. I would have to reassemble the stretcher around him. As the final passengers left the plane I prepared the stretcher. Putting the left side down on the bed underneath his back, underneath the bedsheets as I had been instructed. I then asked him to roll towards me on the other side, which he was able to do, whilst I placed the other part of the stretcher underneath his other side. Hmm, there’s supposed to be a clicking sound as the pieces snap together. Why isn’t there a clicking sound?
I felt for the location of two pieces underneath the patient, Oh they are slightly misaligned. A slight shove upwards of the right side piece and CLICK it went into place. Okay just need to put together the head and feet components, then strap the patient in. By this time four burly porters had made their way to our seats, ready to help carry our patient off the plane. I gathered my medication bag and other equipment and we walked down the aisle to the back of the plane.
In healthcare it is important to set clear boundaries in order to care for yourself and your patients in a sustainable fashion. In the practice of palliative care, boundary setting is even more important, as the therapeutic relationship can be very intense and intimate at times. We have to keep in mind that this relationship will likely end soon, with the death of our patient. It can be a difficult balancing act; using your humanity to make important connections with another human being; while at the same time keeping professional distance to protect the both of you.
That being said, it is inevitable that there will be some cases which will hit you harder than others. When a deeper connection has been made, you will feel the loss and grief much more strongly. Informal reflection with your team members and professional supervision have an important role to play in keeping us palliative care providers safe to continue doing the important job that we have to do. We need to remind ourselves that this is a job that not everyone in healthcare can handle. That those of us who chose to work in palliative care, owe it to ourselves and our patients to look after ourselves. We are a precious resource and if we do not take care of ourselves, we will deny our patients and their families the difference that we can make in their lives, and deaths.
After almost ten years of working exclusively in full-time palliative care practice I would like to share a case that reminded me of just how human I am, and how much value I obtain from professional supervision and from sharing with my team members.
The first time I met the young ladies I had been cross-covering at the hospital, and was taken to see each of them as they both had severe pain and discomfort. They came from completely different backgrounds, had lived completely different lives but somehow ended up on the same journey.
About a week or so later they had both been admitted into our inpatient unit for pain control. Adjustments were made and they became more comfortable, but a few days later pain had returned again, as well as other problems. We had to aim at constantly moving targets, and so it would be over the next three months of their individual roller-coaster rides.
The similarities were startling; the same diagnosis, the same poor response to treatment, and in the end the same prognosis. What was completely different was their individual experiences of the same outcome. Continue reading →