Thursday, May 17, 2007

Yes I totally am a bad person. I apologise. I've got internet at work and in Starbucks (yay for caramel soy lattes!) but I've spent so much time sending emails to friends that I haven't sat and written a post.

I have written a list of things to post about tho... I just need to get round to writing them!

It's been a fantastic, amazing and sad few weeks. I have met some of the most wonderful people - hospice staff, volunteers and patients. The thing that always gets me about Hospice is the laughter and the joy you meet in people everywhere. There is so much love.

One hospice volunteer told me:

'People always ask if its depressing when a client dies. It isn't. It's sad when a client dies, but it isn't depressing.'

That for me is the core of working in palliative care - it's sad when someone dies, but you are there to facilitate that death. You knew that the person was dying when you began the relationship - it was always meant to end. Hospice care is not depressing.

However, when someone dies unexpectedly it can be.

One of the women I have been working with killed herself last week. It was shocking for the whole team, and very distressing. She had suffered from chronic severe depression for many years, but recently had been doing 'better'. I think that she realised how low she had been and made the decision that she would never feel like that again. And this was the only way to be certain of that fact.

I hope she's found peace at last.

ps this is very disjointed - just re-read but can't be bothered to clean it up! sorry guys!


Tall Medstudent said...

Sorry to hear that. :(

The Shrink said...

In palliative care medicine, you know folks will die.

In most medical specialities (cardiology, oncology, colorectal surgery, whatever) you accept some patients will have pathology that will kill them.

Is medical care of mental health that different? Oddly, as you say, it often is. If someone with angina suddenly died of an MI it's seen differently from someone with depression suddenly dying from suicide.

Two thoughts :
- suicide could arise from severe depressive illness and as such her illness claimed her (but, as you say, she's not hurting any more, now).
- she wasn't that ill (as to be psychotically depressed) and instead made an elective choice, her choice, to stop being hurt.

Illness, as medics, we can treat. Personal freedom and patient choice, we advocate.
Either way, suicide in mental health care (which will always happen) can be managed, just as loss in paliative care can be . . .

Anna said...

Thanks Tall.

Hi Shrink! Thanks for your comment. Wow, I wasn't really expecting anyone to put that kind of in-depth comment to my waffle.

Yes, people die in all specialities. Which begs the question, why do we have a speciality just for people who are dying?

Although I think that we do need palliative care docs due to their superb expertise in facilitating dying for patients and their families, I also think the concept and philosophy of palliative care should be part of all (most?) doctors' bag of tricks. Doctors care for people and people die. Death is not optional (tho sometimes I think certain medics think it can be...) and we have to get used to that whatever field we're in.

(Bleugh! Porridge through muslin poor little brain. It knows that it means but is being particularly inarticulate)

Marysienka said...

We need palliative care as a "specialty". it's not every one who is able to get a philosophy when it comes to death. And I think I can understand that. Doctors have a whole lot to deal with and it's hard to ask them perfection. As humans, we are not perfect and even if you go in medicine, it doesn't mean you can cope with every aspect of life. We all have our little bugs ;) And also, we don't see medicine all the same. Like in ortho, they are there to "fix" people, as if we were a machine or something. They don't like chronic conditions, or disorders that don't have a quick solution. It is ok, we're all different in what we like and in our identity.
In pall care, you need to jungle with meds to keep the patient comfortable, and of course, take care of all the bio/psycho/social part of the person. I think this is a lot to deal with, especially since you have to be with the family all the time during the dying process and after the person's death.

I do get your point though and I agree most doctors should get the palliative care philosophy. Not only for the patients they are losing, but also for those who are still alive. Honestly, some doctors would really benefit from it...

Marysienka said...

hey you, what's up??