Palace of Care – Timing

Photo by Taras Chernus on Unsplash

Where do you think you are at?

I’m so tired, it’s no good.

What did the hospital doctors tell you?

It was always bad news. Every time they came in there was more bad news.

One thing, after the other. It would be hard to keep up.

Yeah, it was.

Did they talk about how much time you had left?

No. They wouldn’t tell us.

They fobbed you off?

Yeah.

Would you like to know how much time you have left?

Yeah, please.

How much time do you think you have left?

Not much, I feel so weak. Days?

I think you’re probably right, maybe only days, but it could be much faster if the changes continue. You had a fever last night.

My legs and tummy are swollen too. The doctors talked about something called albumin being low.

Albumin can be a marker of how well a person is, normal levels are 35, yours is much lower.

I feel better since I came over to hospice. Being able to go outside is so good, I hadn’t been outside of the hospital for two months.

Is there anything else we can help you with?

Do you guys have any Coke, in a can?

Sure, we’ll arrange for some Coke for you. Ice?

Yes please.

Just let us know if we can help you with anything else. See you later.

Thanks, see you.

How much time have I got, doc? via @ConversationEDU

How much time have I got, doc? The problems with predicting survival at end of life

Sarah Winch, The University of Queensland; Bill Lukin, The University of Queensland, and John Devereux, The University of Queensland

Predicting how long a patient will survive is critically important for them and their families to guide future planning, yet notoriously difficult for doctors to predict accurately. While many patients request this information, others do not wish to know, or are incapable of knowing due to disease progression.

Fuelling this complexity are families who prefer the patient not to be told for fear of torpedoing hope and reducing the quality of time remaining. Conversely, patients may want to know themselves, but do not want to distress their loved ones with this knowledge. Continue reading

Elsewhere in the Palliverse – Weekend Reads

photo by David Mao itsdavo

I hope you enjoy this selection of articles (and some links to photos and videos) about palliative care, research and related topics. If you make it to the bottom, I’m interested to know what you think of the last link. Please share your thoughts, and any recommendations, in the comments section.

  • “Why is so difficult to prognositicate?” asks neurologist Jules Montague, examining cases of poor prognostication throughout history. (Why doctors get it wrong, The Guardian UK)
  • Team Palliverse still have a place in our heart for textbooks, and we love it even more when their editors write blog posts. To mark the release of the fifth edition of the Oxford Textbook of Palliative Medicine, the OUP blog is publishing a 3-part series titled “Facing the challenges of palliative care”. Part 1 (Continuity) and Part 2 (Development) are available now. (Oxford University Press)

Continue reading

“Sonia’s sign” – conjunctivitis as a novel indicator of the terminal phase?

Generations of junior medical staff had internally rolled their eyes when I voiced my theory about conjunctivitis meaning that the patient would die soon, then been astounded by my prognostic skills when the patient deteriorated into the terminal phase. It was time to put my reputation where my mouth was and do a prospective audit. Did diagnosis and treatment of conjunctivitis in the inpatient palliative care setting mean that the patient had a very poor prognosis? Continue reading