How are you?
I’m terrible.
What’s troubling you?
Everything.
You’ve had enough haven’t you?
That’s right.
We’re not going to do anything to extend your life.
Thumbs Up.
We are going to work on your pain and nausea. Make you comfortable.
Thumbs Up.
It might make you sleepy.
Double Thumbs Up.
Would you like us to help you shave?
No, that’s a job to leave to the undertaker.
You haven’t lost your sense of humour.
No, that’s something I’ll never lose.
My consultant asked the young man, “What would you like us to call you?”
He answered, “Your highness.”
“Okay your highness, how have you been?”
That was an entertaining start to the therapeutic relationship which put everyone at ease, and allowed for an air of playfulness to come into the clinical encounter. The patient was in his late thirties and had come into hospital with severe pain. It was likely due to cancer metastases, and he was still recovering from his last cycle of chemotherapy when we visited him.
He talked about what was most important to him, spending time with his young son. This was whilst he was carefully mixing flax seed oil into a serving of yoghurt, as part of a cancer treatment diet that he was trying. He would try anything to keep himself going and wanted to spend as much time with his son as possible.
Despite all the treatments that he had received the cancer continued to progress causing ever more problems. The side-effects of the aggressive treatment were severe and included the loss of his hair. He said that he had always had good hair, and it was one of his personal trademarks since he was a teenager. Now he didn’t mind losing his hair, and he had even designed a t-shirt for the sake of entertaining himself and those who looked after him.
He loosened his dressing gown and revealed his creation. In bold font it simply said, “Hair by Chemo.”
How you doing?
Okay, I’m feeling better than yesterday.
They told me you had a lot of pain overnight. Pain can make you really tired.
Yeah, I haven’t been the same since I was in hospital.
When did the mouth get bad?
Since hospital.
And your skin, when did it start getting bad?
Hospital too.
Was that when they started the steroids? Have they helped?
I don’t know, I don’t feel any better.
Anything else wrong?
Heh, my arse is really sore too.
What do you think is going on?
Not much, I’m just really tired.
Your lungs haven’t been so good since you were a kid, then they got worse with the COPD. That wasn’t enough for you? Then you got heart failure and then cancer. That’s a bit greedy isn’t it?
Heh, yeah I guess so.
What did the doctors tell you about your cancer?
It started in my lung, has gone to my tummy, here, here and here. Also gone to my back.
That’s pretty serious, it’s made you lose weight eh?
Yeah, heaps, I just don’t feel like eating anymore.
Anyone else got cancer in your family?
Yeah my parents both died of it, and two of my sisters have it too.
That sucks.
Yeah it does.
Could you try using some more pain relief?
Okay, I’ll try.
Are you a spiritual person?
Yeah, nah, not really.
What’s the most important thing to you in the world.
My whanau/family.
What do you like doing, what keeps you going?
I like to draw, and I’m a carver, I carve bone and wood. My son is a carver too.
Heh, I can carve too…Ham on the bone, leg of lamb, roast of beef. I’ll bring my friend’s wood carving over to show you later.
Sounds good, thanks.
We at Palliverse love a conference, especially one that “brings together doctors working in palliative care” in Aotearoa/New Zealand.
The 2017 ANZSPM Aotearoa Annual Conference and AGM will be held in Christchurch this year. It all starts off with the Trainee Day on 11/08/17 which is open to all Palliative Medicine trainees, General Practitioners with a special interest in Palliative Care and Medical officers working in Palliative Care.
The 2017 Annual Education Update Programme is packed with many topics of interest, and will be a good opportunity to catch up with what is going on all over the country, as well as catching up with new and old friends. This year Dr Wendy Pattemore will be introducing a new session called, “Wild Successes and Fabulous Failures,” which will provide an opportunity to share how Palliative Care is done in your own ‘patch’.
To register you can either use this 2017 Annual Education Days and Trainee Day Registration Form or register via the website. Attendees must be ANZSPM members. Our friends from Australia are always very welcome!
For my reflections from the 2015 ANZSPM Aotearoa conference, click here.
In New Zealand last week we celebrated Hospice Awareness Weak and to tell you the truth I’m not sure how impactful the week actually was. Continue reading
This blogpost is dedicated to a patient that I never thanked for the part she had to play in my palliative care education.
The sharing of patient stories can have a huge role to play in the education of healthcare practitioners and laypeople. Palliative Care health literacy remains relatively low despite palliative care services having been present in Australia and New Zealand for well over three decades. Relatively few healthcare practitioners let alone members of the general public understand the role that palliative care services can have in the improvement of quality of life. Are we sharing the right stories, in the right places, to the right people?
Hi everyone,
Here is a copy of my slides from the Keynote presentation that I made on 16/09/16 at the Hospice New Zealand 2016 Conference.
I was intentionally being provocative and I was purposefully trying to challenge the audience’s mindset with the material that I presented, as I believe that New Zealand Hospice/Palliative Care needs to be “shaken up,” if it is to remain relevant. Now it’s your turn, you have been warned…
I am working on a version which will have clickable links, and also on a recorded live performance of the presentation. In the meantime the slides with comments have been loaded onto the Palliverse Instagram account.
Cheers,
James
After a tough fortnight at work I decided to change things up a bit at our Multi-disciplinary team meeting this morning.
We’ve been using an iPad to take notes from the meeting for a while now, and today I tried to make it a more multi-media affair.
As well as recording the patients’ stories I also tried to match each of them to an appropriate piece of music.
The rather diverse playlist and patient list eventually became:
Tammy Wynette – Stand by your man – after discussing a man whose ex-wife had returned to look after him.
Imagine Dragons – Radioactive – the correct pronunciation of a patient’s surname.
Avril Lavigne – Complicated – a patient’s complex family dynamic.
The Black Eyed Peas – Where Is The Love – a patient’s long-term relationship with their spouse.
Alicia Keys – Falling – a patient who had repeatedly been falling…over.
Bob Dylan – Blowin’ in the Wind – a patient with malignant bowel obstruction who had started passing flatus.
Cheers,
James
Hi everyone,
Join me in sharing stories from the lighter/brighter side of Palliative Care.
Cheers,
James
palliverse.com 