I think therefore I am? – Right and Wrong

Photo by Andrej Lišakov on Unsplash

It is important for me to do the right thing for my patients. In order to do this I need to know them well enough to know what the right thing for them is. I have my own ideas but they might be completely wrong or completely against what they think is right for them. I have to be careful not to fall into the trap of thinking that I know better than the person themselves. They are the expert when it comes to themselves not me. They are the owners of their own lives and have been making decisions for themselves for the whole of their lives. They were not born yesterday, but in the case of palliative care patients, they might die tomorrow.

I look after patients but that does not mean I own them. They own themselves. Prior to meeting me they were fully grown adults, living their own lives, making their own choices, choosing their own destinies. My job is not to tell people what to do. My job is to find out what people need and to try to help them with it. If my set of professional and personal skills can help them meet their need then I can help them. If I don’t possess the skills they need from me then I will refer on to someone who does have those skills. It’s not about me, it’s about them.

It is disrespectful to treat people as if they are children when they are fully grown adults. I worry about some people who work in palliative care doing that, treating people as if they were babies. Incapable of making their own decisions, needing us to make decisions for them. This is the wrong thing. Taking on the role of a parent, but we are not our patient’s parents. How would we feel if we were treated like that? Disempowered, disrespected, dismissed?

Palace of Care – True Flies

Photo by Dieter Pelz on Unsplash

Every summer the hospice is visited by thousands of flies.

We are situated next to a big park and flies are a constant presence in the warmer months.

They can be really annoying for our patients who may be too weak and tired to fend them off. Their family members may also have troubled keeping the flies away.

Every summer I have said that I would bring in an electric bug-zapping racquet to deal with the flies.

This summer I finally brought one in.

In recent weeks as well as doing a medical round I also do a fly-catching ward round at least once a day.

I made myself available 24/7 on-call for the purpose of catching pesky flies. I can be called in any time of the day or night.

This has led to great amusement for patients, family and staff members.

Yes, I am probably the most highly qualified pest control worker in the country.

As well as catching flies I practise some medicine as well.

I clear each room of flies and then I head outside to the balcony area and get rid of the ones that are out there as well.

It’s one man against thousands of flies but if it makes my patients’ time slightly more bearable it is worth it.

It is also a good way to add to my daily step counts.

I will continue to catch flies and expand my repertoire of work roles.

This is especially important each and every Flyday.

I think therefore I am? – SEP

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Ford Prefect says, “An SEP is something we can’t see, or don’t see, or our brain doesn’t let us see, because we think that it’s somebody else’s problem. That’s what SEP means. Somebody Else’s Problem. The brain just edits it out, it’s like a blind spot.”

The Somebody Else’s Problem field… relies on people’s natural predisposition not to see anything they don’t want to, weren’t expecting, or can’t explain.

From Douglas Adams’ Life, The Universe and Everything 1982

The SEP field generator is an incredible thing, where-ever you shine the beam, like an amazing piece of magic, suddenly the problem disappears and becomes someone else’s problem.

Sound familiar when you think of palliative care patients and their problems?

Other specialities do this to us all of the time, they leave work unfinished or not even attempted. They somehow know that us good-natured folks will make sure that things are sorted.

This isn’t really fair to us, but especially unfair to the patient. Where is the patient in all of this? Certainly not in the centre of attention.

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Palace of Care – Polypharmacy Pals

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Not Cap’n Crunch cereal but he ate them like lollies, 5 tablets at a time crunched in his mouth like candies. It was strangely fascinating to watch him do it.

Were they really helping him? We didn’t really know, but that’s what his Cardiologist had recommended at their last appointment, and as a model patient he would follow the instructions carefully.

It hadn’t always been like this, two years before life in his small town was normal. Not much to do in the weekends, so like everybody else his age he dabbled in recreational drugs.

Weeks later and his breathing became worse, he thought it was due to a reactivation of his childhood asthma. He didn’t do anything about it but then things worsened and he went to see his doctor. He was prescribed Asthma inhalers but they were ineffective. Back and forth to the doctor he went, with no improvement. A chest x-ray was ordered and surprisingly showed severe heart failure. Further investigations were performed including an echocardiogram. Working diagnosis was of severe cardiomyopathy secondary to methamphetamine abuse. The drugs he used had left his heart permanently damaged.

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I think therefore I am? – Hearts and Minds

Photo by Jon Tyson on Unsplash

To do palliative care and hospice well your heart does need to be in it. People can easily tell if you are not really there. It doesn’t have to be as obvious as someone who won’t sit down, or who constantly checks the time on their watch. Do you have somewhere more important to be at the moment, than in my room? Something more important that needs to be done than listening to me?

If someone’s heart isn’t really in it people can tell right away. The lack of attention that is paid to simple things. So we do want people to be engaged to actually care for people. It does need to be done professionally, with kindness and respect. People need to have firm boundaries that they do not cross. It’s about protecting yourself and also the person that you are working with. You can be friendly but cannot be their friend. You can be caring but it must be in a professional manner. We are guests in their lives, and we do not want to disrupt pre-existing relationships.

We are involved possibly in the final chapter of someone’s book of life. It is not about us, but about them. They are the stars of their own show, of their own movie, of their own stories. We are only extras, or play a tiny bit part. We may have only a few lines to say, and we will try to say them well. The direction of the story needs to be guided by the person going through it all. We would not be in the same room as them if they were not sick, if they did not need the care that we can provide. We must never forget that, that they are not here because of us, but that we are all here because of them. The patient needs to be at the centre of everything that we do, not their family members or friends but the actual person themselves.

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Bedside Lessons – 8. Forequarter Amputation

Photo by Fausto Marqués on Unsplash

He was found on the floor after having fallen down while walking back from his bathroom. A human arm should not have been able to bend at the odd angle that his arm was in. He was in terrible agony and an ambulance was called to take him to hospital.

I met him the next morning on the post-acute ward round. Overnight he had his fractured arm operated on, and screws and plates had been installed in order to fix the broken limb. He needed help with toileting and needed help with feeding. His other limb had been affected by cancer some years ago and had been removed along with his shoulder in an operation called forequarter amputation. It was terrible luck that his remaining arm had been badly injured.

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I think therefore I am ? – A special Totara Hospice South Auckland event this Friday.

07/12/17 – Update – Attendees please note that tomorrow morning in Auckland there will be a Railway Workers Strike meaning that road traffic will likely be much heavier than usual. We have asked attendees to arrive at 8.45am for a 9am start, please factor in the strike traffic delay when planning your travel for tomorrow morning. If you arrive early you can visit our on-site Cafe Totara for a fresh Barista-made coffee, with a range of fresh food available as well, all prepared on-site. An email update will be sent to attendees who have already registered.

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Hi everyone,

Can healing occur at the end of life?

To whom does compassion need to extend to at the end of life?

These are the type of questions that will be explored in Totara Hospice South Auckland’s education centre this Friday morning, 08 December 2017 9am to 12pm.

We are privileged to be hosting two international speakers.

Dr Rob Rutledge will be joined by a special guest.

We will be honoured to also have in attendance, Tibetan Buddhist Monk, Za Choeje Rinpoche.

zach

Please join us for a very special interactive workshop in which we will attempt to challenge your thinking and change the stasis quo.

RSVP details are contained in the below pdf.

Morning tea refreshments will be provided.

Please pass on this invitation to anyone in your networks who might be interested in attending.

Cheers,

James

Invitation Compassion and Healing Seminar.pdf