Tag Archives: homeward

Palace of Care – Palliative Care Travel Agency

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Photo by Kelli McClintock on Unsplash

Practicality

We often complain about what we don’t have here in New Zealand regarding our health services while taking for granted what we do have. Our South Pacific Island neighbours have much less than we have and access to medications is limited. Strong pain relief for severe pain is hard to find and people may die in pain and with other uncomfortable symptoms. This all needs to be taken into consideration if you are discharging someone who is returning to their home overseas.

What medications will our patients take away with them? There may barely be access to oral opioids in their home country, don’t even think about subcutaneous injections. Syringe drivers cannot be continued. What can you switch the injectable medications for? Transdermal patches can replace the pain relief component. Consider medications that can be given sublingually (for absorption by the mucosa under the tongue). Anti-nausea agents, anti-distress medications, and pain relief can be given in this way. Up to a month’s worth of medication can be prescribed and prepared the day before the flight by the dispensing pharmacy.

At the usual airline cruising altitude of 30,000 feet oxygen availability is reduced by almost 30%. Oxygen may need to be available. To lessen the need for toileting during the flight consider giving enemas the night before. Indwelling urinary catheters could be inserted to take care of peeing. Provide medications that will be needed on the flight such as pain relief, nausea relief, and distress relief.

Reality

Once the hospice team had decided on a plan everyone sprang into action on the Friday afternoon. The Pacific Cultural Liaison met with the patient and family. One-way air tickets were booked for travel in two days. Blood tests were taken and the results would be back by Saturday morning. The rest of the family prepared their travel plans too. A mixture of excitement and fear were the main emotions shared. Would she be able to make it home?

Saturday morning she was cleared for discharge home to local family. A chance to say goodbye to her loved ones before Sunday. Many tears and hugs were shared as people realised it would be the last time they would ever see her.

Tearful goodbyes at the airport. Onto the plane and a nervous four-hour flight. Exhausted but unable to sleep. Focused and determined to make it home after being away for the two hardest months of her life. Thinking of all the people she needed to see. What’s going to happen to the kids? Touchdown and it took the longest time to get through customs. The bumpy ride home and everyone that meant something to her was waiting there to welcome her.

An afternoon and evening full of goodbyes, there was laughter amongst the tears as memories of good times together were shared. It was hardest for her parents and their siblings to handle. Daughters/nieces are not supposed to die before you do. Exhausted but fulfilled she fell asleep in her own bed, with her family all around her. She had never been so tired before but she had made it home.

At 9 o’clock the next morning a brave and determined lady’s breathing slowed down until there were pauses of up to ten seconds. The pauses eventually grew longer and longer until she finally stopped breathing.

Kia ora everyone, there will be a break from usual transmission for the next ten days as I take a holiday and have a digital detox, see you back on 28/02/24.

Palace of Care – Keeping a Promise

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Photo by Thomas Serer on Unsplash

In our family, our word is our bond. When we say something, we mean it. We promised him we wouldn’t take him back to hospital after his first operation. But we broke the promise because he was too unwell. He had another operation but it didn’t work out, everything fell apart. He was in too much pain. We again promised him not to go back to hospital, but then the blood clot happened. He was in so much pain, and we had to wait so long before the nurses would come to see him. We were all crying, all three of us.

He wants to go home. Even if it is just to die at home. To watch one more football game with his son. That’s all he wanted. To go back to the home that he built for us. We kept asking them to let him go home. Instead, they sent them here to your hospice. This place is nice enough. You people are all nice, but he wants to be at home and spend time with his family.

This morning he’s different. He’s lost all hope. He started saying goodbye to his house. He thinks he’s never going to get back there. He thinks he is going to die here. We had to get out of hospital yesterday. We couldn’t take it any more. We’ve broken our promise to him again, to take him home. I’ve never seen him like this before. What can we do now?

He’s really unwell. I think his bowel is blocked. I think he is dying. He might only have days left to live, but it could be much shorter. We haven’t been able to make him comfortable yet, but time is running out. We have a chance to get him home today. I’d rather he be more comfortable but I’m worried that if we don’t get him home today, he will miss his opportunity. I know how important it is to him and the whole family to get him home. We can make it happen today.

I’m going to stop the blood thinning medication, as it won’t be able to help him any more. I’d much rather he die quickly from a blood clot than die slowly from a bowel obstruction. I know how much he hates vomiting and making a mess. I know you are all still upset about what happened in hospital but I need you to focus on your husband while he is still alive. You can sort out the hospital stuff later. Right now we need to teach you how to give him injections so that you can look after him at home. All right, we need a bit of time to sort out the prescriptions and other stuff. We’re going to make this happen.