Palace of Care – A difficult post to write

I started writing this post two years ago, and I tried to complete it this time last year but I wasn’t able to. I have finally completed it today, and it serves as a sneak preview chapter for my upcoming book Bedside Lessons which will be available for purchase on Amazon Kindle on 09 June 2022.

Photo by Sooz . on Unsplash

Death Jumps The Fence – I miss my mum

Every Friday I usually wear a fish neck-tie and chips socks, this is in honour of my parents who ran their fish and chip shop for 35 years. Friday was always the busiest day thanks to ancient papal decree. Mum loved to work in the shop and chatted to generations of families who were regular customers. Mum’s eyesight was destroyed by an autoimmune condition called Uveitis. This stopped her from driving her car that she had owned since it was brand new. A red 1982 Toyota Corona – Popularity has decreased since 2020. Not being able to drive limited Mum’s independence. Her partial blindness in one eye, and near total blindness in the other didn’t stop her working. Somehow she would still cross one of my hometown Napier’s busiest street to walk to the shop. She loved serving her customers and always had a friendly smile for them. Apart from rheumatoid arthritis and a blood disorder, Mum’s health was good until her final illness.

It all started early one morning, when severe back pain woke Mum up. She was rushed to hospital and couldn’t move her left leg. The initial differential diagnosis was of a stroke but the head scan did not reveal any brain issues. Further tests discovered a blood clot which had blocked the spinal artery which supplied the area of spinal cord controlling the left leg. Mum had been troubled by a blood disorder for the previous five years. This led to her blood being thicker than usual, which may have caused the clot formation. Blood thinning medication was started. Other tests discovered a suspicious mass lesion in her chest. A biopsy was requested.

Whilst awaiting the biopsy Mum was reviewed by a lung doctor who bluntly told her that she had cancer, and that she would need to have intensive treatments. These would need to be done at the regional cancer therapy centre, two hours drive away. This sent my Mum, who was always a bit anxious, into a tailspin. She stopped eating, couldn’t sleep, and was inconsolable.
Mum had a good memory throughout her life, but in the months prior to this illness she had started having short term memory loss. Looking back at this her illness had likely taken its toll on her memory. Two days after the bluntly delivered unconfirmed diagnosis Mum had forgotten what had been said, and was able to continue her recuperation. She knew that a biopsy had been arranged but could not remember what for. The prospect of it terrified her.

I flew back to Napier on a Friday morning to help Mum get through her biopsy. She was scared and needed her hand held. The radiology team who were performing the biopsy ushered me in the room, and I gently told Mum to take deep breaths. I explained to her in Mandarin Chinese, “There will be some pain from an injection. Then your skin will go numb. They’re about to put in another needle. It shouldn’t hurt, let me know if it does. There will be some pressure but it shouldn’t hurt.”

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Bedside Lessons – 21 – Overcast Sky

Photo by Malte Schmidt on Unsplash

100 years ago, when I was still a trainee registrar, I asked myself, “what were we going to do?” I was about to admit the kind of patient that hospital doctors would be eager to transfer to the local hospice. I’d done exactly that in my previous hospital role, but I was then working in the local hospice and would have to deal with the situation myself.

She’d been nauseated for two weeks in hospital. They had tried everything and nothing had worked. The last weeks had been rough for her, and even in that short amount of time she had lost weight. Her appetite was suppressed to nothingness, as she felt too sick to eat anything. The mere sight of food put her off completely.

After I finished the admission I felt miserable myself, some of her misery had rubbed off on me. Was this transference, or counter-transference? Something about the situation that she was in made me feel similar to what she was going through herself. What to do? One option was to stop all treatments and start all over again. That’s what I did.

The next day I found myself leaving the miserable lady until the end of the ward round. I did not want to catch her misery again in the fear that I would spread it throughout our inpatient unit. I was trying to avoid her as yesterday’s experience had made me feel worse for wear. She had made my heart sink and so I put her off for as long as I could. Things hadn’t really changed much, and I had another dose of misery before lunch time.

By day three I felt bad for being unsupportive of the patient and I promised to myself that I would try harder to connect with her and decided to see her earlier in the ward round. It wasn’t her fault that she was so miserable, it was the illness making her so, and we hadn’t been able to control her symptoms. Walking into her room I braced myself for the tidal wave of negativity. I held onto the door jamb as I entered her room, expecting to be sucked into the black hole of her misery.

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Bedside Lessons – 9. Doctor to Doctor Part 1

Photo by Usman Yousaf on Unsplash

Doctors are humans too and can become just as unwell as anyone else. When a doctor is assessing another doctor it can feel a bit strange. You might be assessing someone who has had the same training as you have, who may have worked as a doctor for much longer than you have yourself.

I’m usually calm in my approach to patients, well at least that’s what it looks like on the surface. I remember being particularly nervous one day when I was in my second year of being a doctor, as I had to admit one of the Professors that had taught me during medical school. One of the nicer guys who was always generous with his knowledge and time, always trying to nurture the next generations of doctors. He was not well and needed a complete work-up.

I started to see him and the usual procedure involved inserting an IV line and taking off some blood tests. I was about to stab one of Prof’s veins when the head of the department, a female professor, who had also been one of my teachers walked in and watched the proceedings intently. The needle went in, blood was taken, and then my patient Prof number one turned grey and looked like he was about to faint.

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I think therefore I am? – Life can literally be too short

Photo by Heather Zabriskie on Unsplash

You’d think that we know this all too well working in palliative care/hospice but we are just as human as everyone else. We also get lost in the busyness of life in general. Rushing from one appointment to the other and having to switch roles as seamlessly as possible. I am no different to anyone else. I don’t have all the answers and am still searching for them myself but I want you to have a think about some questions I raise below.

Life is too short could be a stimulus to reflect on how you spend your time. Are you in a job that you actually enjoy? Do you feel like you are making a difference. We spend a lot of our time at work, 8 or more hours a day, maybe for 40+ hours a week, month after month, year after year. A big chunk of our lives is spent at work, and you may be spending more time with your workmates than you spend with your own loved ones, friends, and family. Are you happy at work or is there something else you’d rather do, somewhere else you want to be? Does it still satisfy you professionally? Are you finding yourself enjoying what you do or do you find yourself putting up with things? What would be your outlook on your job if you only had 10 years left to live? These are questions that we don’t ask ourselves, but are situations that my patients have found themselves in.

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Palace of Care – Wellbeing Tips

Hi everyone,

I shared some wellbeing tips with my workmates and they produced a pdf file that you can download.

Guest Post by Liese Groot-Alberts

Liese is an experienced Palliative Care Educator, Mentor and Clinical Supervisor who has helped and inspired many people in New Zealand, Australia, the Pacific Islands and many other countries. I’ve had the pleasure of seeing Liese present live in person at various conferences and workshops, which has always been a real treat. Liese has kindly shared some of her personal thoughts in the hope that they will help others during the trying times that we all find ourselves in. Thanks Liese!

 

The art of communicating compassion in PPE: Pantomime of Purposeful Expression.

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“ behind glass” by Marta Bevacqua, Paris

 

“Make your choices based on love, not fear” – Dr. Elisabeth Kübler-Ross

In my work as a mentor and clinical supervisor of healthcare staff, I am currently hearing expressions of grief, frustration, anxiety, concerns and sometimes a sense of powerlessness in this Covid-19 pandemic. Staff are talking about feeling clumsy and inadequate in their communication of compassionate care to patients through layers of PPE. This combined with a high-powered, stressful, anxious working environment makes it paramount for staff to commit to time for self-care and self-reflection, increasing their awareness of how they are in body, mind, heart and soul, in order to be able to practice compassionate care.

I repeatedly hear: “I don’t have time for self-care or reflection, I am too busy juggling work and home, I feel like I am running all the time.”

I totally agree, life before covid-19 was busy enough and now is for most – in essential services especially- even more pressured. However, I also would like to challenge your statement of “no time” with a simple exercise to do at work, that takes about 15 seconds, can reduce some stress and anxiety and be helpful in re-connecting you with your compassion.

Unless you are on your way to an emergency of course, then just take one deep breath and run!!! Continue reading

I think therefore I am? – A definition of Grace

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http://www.flickr.com/photos/144232185@N03/30117339256″>PARMIGIANINO,1534-35 – Deux Canéphores se donnant la Main (Louvre INV6466)

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.

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Art therapy for the palliative care clinician

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I had wanted to learn to paint for many years, and finally found the time to take some classes during my research fellowship year. It was really good fun and I loved it. Unfortunately, my fellowship year soon finished and clinical commitments meant I could no longer attend the classes.

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Nevertheless, I decided that I would keep painting, once a week (usually on a Wednesday), just for me. At the end of a busy day, it’s often easier to just slump on the couch and watch some TV. I’ll be honest, sometimes the couch wins. However, I do manage to drag myself out of the house again most Wednesdays, get myself down to the studio for a couple of ours of what I fancifully call my ‘art therapy’ before bed. And when I do, I never regret it.

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As you can see, I’m just a beginner and still have a lot to learn about painting. But I love losing myself in the work, just thinking about form and colour – anything other than patients and families and suffering and medicine, or audits or guidelines or research or presentations. I also love heading out and painting outdoors when I can get away.

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If you also like painting, or any other form of art – please join us for #PallANZ tweet chat on the 29th, which will be on the topic of “palliative care and the arts”! You can find the details here.

Harassment in healthcare – What can palliative care learn from the RACS?

As many of you would know the Royal Australasian College of Surgeons has recently released its expert advisory group Draft Report into discrimination, bullying and harassment in surgery.  The results of the report are confronting even if they are unfortunately not altogether surprising.

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New fellow survey

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(Image via wikipedia)

Are you a “new fellow”? Have you recently qualified (or about to qualify) as a palliative medicine specialist (FAChPM +/- FRACP)?

Transitioning from advanced training to consultant-hood can be a challenging time in one’s career. Help us understand how best to support you by completing this brief and anonymous survey: https://www.surveymonkey.com/s/NZ97VVL

Thank you!