Palace of Care – Yellow Fever

Photo by Vanessa Bucceri on Unsplash

She had told her family about my promise to paint my fingernails to match hers. She had painted her nails to match my bright yellow scrubs. When I examined her fingers the nails were of many different colours. Some were yellow, others were black, pink, and red, all of them nicely painted. She showed her nails and she made us all laugh. This included both staff and her own family. I joked about needing help with nail-painting supplies, as I didn’t usually paint my nails. If I was going to do so then I might as well do my toenails. I shared with our audience that my yellow nails would go down well at the Brazilian Jiu-Jitsu club I belong to. We all shared some more laughs before we came to the serious part of the family meeting.

I provided a recap of what had happened since our patient was admitted. She arrived with terrible pain, nausea and constipation. These symptoms were controlled with adjustments in medication doses over the first week. Well-controlled pain came at a cost. Our patient became confused at times. We had to make dose changes but we wanted to persevere and bring down the pain levels as much as possible.

Overall the pain and nausea improved but the confusion episodes worsened. We tried to prevent further episodes to no avail. I talked about the ongoing changes in her situation. Old problems became worse while new problems developed. We were trying to play catch up with a disease process that wouldn’t stay still. She had been having ups and downs due to medication effects but mostly due to worsening cancer.

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Palace of Care – True Colours

Photo by Rae Tian on Unsplash

I chose yellow as my favourite colour when I was five years old. It was the colour I used for the suns I drew. A bright colour that evoked a feeling of warmth. My kids bought me a set of yellow scrubs for Father’s Day. Really bright yellow scrubs. When I am wearing them at work most people will respond in some way.

The yellow scrubs seem to provide a lot of people with an almost religious experience. Many people after seeing them have said, “Oh my god.” They also cover their eyes with their arms and turn their faces away whilst grimacing. Other people have requested a warning before I enter rooms in order for them to prepare sunglasses or welding masks.

Some people who see the scrubs don’t like them at all. A small number of people have said they like them including a number of patients and their family members. For one patient it is their favourite colour. I have been particularly worried about them and I have been wearing them at least once or twice a week. I am worried my patient will die soon and I wanted to wear the yellow outfit as seeing it previously had made them smile and laugh. Especially the first time I wore the scrubs when the patient changed into a yellow outfit. We both also had colour co-ordinated socks. A colour co-ordinated coffin had already been purchased.

Yellow is the colour of many of the flowers around our hospice. The colour of the medication cards is also yellow. The patient with the severe itch from jaundice had yellow skin, and the whites of their eyes had turned yellow too.

Another patient has taken a liking to my bright yellow scrubs and requested me to wear them more often. The last time I saw this second patient they had painted their fingernails in a matching shade of yellow.

Hmm, what colour will I wear tomorrow?

I think therefore I am? – Starts with P and ends with O

Photo by Ray Harrington on Unsplash

It’s important to celebrate the small victories we achieve in palliative care, as they are often hard-won. When the natural history of illness is one of disappointment and loss, it is important to mark the times of success. Our patient had not passed bowel motions for 11 days. With each passing day, she had felt less and less normal. She wondered if she would ever Poo again. When constipation has taken its toll for such a long time the treatments will be accompanied by pain. Not having the treatment will lead to more pain. We had tried the standard treatments of pills, soluble powders, and various products to be squirted in private, all with no success. We readied the special injection. If it worked it work quickly. The injection was provided and we all held our bated breath in concert. Within 20 minutes we had achieved a result. The cheering was heard from the doctors’ office, at the nursing station. Yahoos echoed down our corridor. I felt the urge to perform a cartwheel. Smiles all around at the arrival of the VIP – Vast Incredible Poo – time to celebrate. Fireworks were lit and the Poo party began.

“Ahhhhh. You’d better call the water department, because their pipes may be blocked as I just passed a two-metre-long Grogan!”
This story soon spread throughout our hospice.
The next day I met the patient for the first time, “Ah, you must be Mr Grogan?”

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I think therefore I am? – Gradients

Photo by Annie Spratt on Unsplash

I went to medical school in the previous millennium. Back in the days when the standard dress code was to wear a shirt and tie. To tell the truth, it didn’t matter too much what you wore as it all had to be hidden underneath the doctor’s white coat that we would wear. I probably would’ve gotten away with wearing just a collar and tie underneath my white coat. I would’ve needed to have appropriate pant legs and footwear but probably could’ve gotten away with wearing pyjamas underneath the coat. Of course, this never happened as I was as sheep-like as everyone else and conformed to the standard dress code.

Once I graduated I became braver in terms of dress sense and I started wearing cartoon ties and otherwise quirky ties. I built my collection during my travels. I bought ties in places like Taiwan, Thailand and Kaitaia. Halfway through my first year of work, I went on a clowning trip in China led by Dr Patch Adams. This was followed by a reunion with my childhood friends in South Korea. On my return, I came to a decision. I decided to retire. All of my standard ties. I would only wear my cartoon ones from thence on. Over the next 21 years, I continued to wear Disney characters, Looney Tunes, Superman, Popeye, Fish, and many more.

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Palace of Care – Terroir

Photo by Rusty Watson on Unsplash

We celebrated International Nurses Day last Thursday with a special breakfast with lots of goodies for all. Nurses are a crucial part of any palliative care and hospice team and it was great to celebrate them with some special treats. Individual paper hats were made available each adorned with little red Superman style shields, thanking them for being heroic in the jobs that they do. Special little bags of sweets were prepared and handed out to all of our staff.

There was a buzz of mirth and fun throughout our inpatient unit and this was noticed by the patients and their families too. One couple commented on it being nice to hear raucous laughter happening outside of their room. It was nice to be staying in a healthcare institution where people were enjoying each other’s company at work. This couple had stayed in many different healthcare institutions over the past years and thus spoke from experience.

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Palace of Care – Hello

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