living your best to the end
Palliative Home Visits are the Future

Palliative Home Visits are the Future

“What I fear the most – what really terrifies me – is being short of breath and not being able to swallow.” So said the husband of his dying wife. This is terrifying to me, too, so I listened closely to the response given by Palliative Care  physician, Dr Sandy Buchman: “I can help with shortness of breath: there are medications that change the perception of that feeling of breathlessness. It doesn’t change the underlying cause, but I see patients whose breathing is still labored yet they say they’re now feeling fine. About swallowing: eventually, your wife will not be able to eat. That’s normal, and I can help both of you cope with that. “ I am in the privileged position of being invited to ‘ride’ with Dr Sandy Buchman on palliative house calls. Working at a teaching hospital, he often brings residents as part of their learning experience, but I am the only layperson to get this access. And what an experience it was: learning more about the palliative approach – to symptom management and to that all-important aspect of any meaningful interaction: communication. We decided my best introduction would be ‘educator’ and, although a bit apprehensive about intruding at a fraught time, I was universally welcomed. In a couple of the visits, I was able to employ ‘active listening’ with family members feeling comfortable enough with me to share insights that proved helpful. A range of palliative patient and family situations A B, 100 years old, on oxygen, was a renown pathologist; L.M., 88, bed-bound, the right side of his face paralyzed, was key economist to...

Palliative Care: Doing ‘nothing’ is not an option

 Dr Daphna Grossman wants to set the record straight “In healthcare it seems we talk about ‘doing everything’ or ‘doing nothing’. With Palliative care ‘nothing’ is not an option. Certainly there are standards and recommendations and then there’s the Art of Treatment: our goal is to treat the whole person – physical, psychological spiritual and social. We look at a person’s goal of care. Can this goal be achieved? Not all illnesses can be cured however, symptoms can be alleviated.” Dr. Grossman is deputy head of the Palliative Care Unit at Baycrest, an internationally respected academic health sciences centre focused on aging, and onsite resident coordinator for their palliative care unit. Her passion for palliative care radiates off her, and she paints this picture: deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpuf deputy head of the palliative care unit, and site resident coordinator for palliative care. – See more at: http://www.baycrest.org/educate/insights-into-aging-101/presenters-bios/#sthash.yuLPPMKA.dpufHer passion for palliative care radiates off her, paints this picture: “If we only treat patients in terms of their physical issues such as addressing their test results it’s like looking at a picture in black and white. We need to also address the context, the person, who they are, and what is important to them to paint a picture that is in colour.” The thing is, people,often perceive Palliative...

Comfort: How important is it to you at life’s end?

For many – perhaps most – suffering is the biggest worry about life’s end. Suffering doesn’t start and end with pain management. It includes peace of mind and comfort – both of which are highly individual, and can hold the keys to perception of and requirements for a ‘good death’: What comforts you, or what brings you comfort? What are your small pleasures, or what gives you pleasure?  What brings you peace of mind? Comfort and feeling good about herself is the gift a palliative doctor gave to a terminally ill patient who wanted no further medical treatment. He simply asked: “What would make this a good day for you?” “If I could sing” The patient, Dolly Baker (nee Thelma Botelho), was once a renowned songstress.  And sing she did. I have sat in countless meetings, workshops, think tanks, round-tables where everything but the word, comfort is used to help us on the way to as good a death as possible. Amongst the questions commonly asked: What are your values? What are your beliefs? What’s important to you? What are your goals of care? These may may all play into what makes us feel good,  and brings comfort, but these approaches often then require further probing and questioning which takes so much more of that precious thing that’s often in short supply: health care professionals time. Revealing answers, reveal simple solutions Answers about comfort reveal solutions that: often have nothing to do with medical interventions; can bring comfort and joy to attending healthcare professionals; can help family and friends support more purposefully and meaningfully; As a ‘layperson’ whose focus...

Bringing Creativity into Clinical Practice with Older Adults.

It was a day of music, arts and drama, of passion and compassion, entitled, Bringing Creativity into Clinical Practice with older adults. Bringing creativity into a Clinic Day brought relief and hope to many working with Dementia and Alzheimer’s patients. The presentation was refreshingly unlike most clinical education and on breaks, we were greeted by a Drum Circle, lead by Terri Segal, Expressive Arts Therapist, Not just a demonstration, we were encouraged to pick up a percussion tool and join in. A combination exercise and mental health break. Another presenter – a psychiatrist –  showed photography assignments from nursing home residents, whose average age was 87, entitled: “A View of the World though the eyes of the Elderly: I’m 90 going on middle Age.” One of the photos – a self-portrait assignment – won first prize at an art show: it had been submitted anonymously and the winner surprised everyone when she wheeled over to accept. Robin Glazer, Director of the Creative Center: Arts in healthcare, in NYC was quick to point out that her ‘arts’ are not the same as Art Therapy. “There is no agenda here. It’s de-stressing and fun. We have excellent artists who are flexible and design their approach to the audience. For example, in a group of Japanese elders, our artist started with simple Japanese brush strokes: something they’d be familiar with.” She told of her own experience – which she attributes to honing her observational skills through art appreciation: “I was invited to Grand Rounds at a hospital that one of our artists is at. I saw a young man with an unexplained...

End of Life in Long Term Care: Personal Support Workers

Personal Support Workers (PSWs) Rock and Rule Anyone who’s needed practical help with daily living when in a health situation knows that it’s not the doctor or nurse you turn to or rely on. Whether at home, or in a health facility, the day to day care delivery falls to the Personal Support Worker. In a workshop organized by the Ontario Long Term Care Association focusing on Palliaitve Care in Long Term Care – with the theme: Care for Life, I sat amongst a packed room-full of (mostly) women PSWs.  Their satisfaction comes not from having the latest medical intervention, or cutting edge equipment but rather from spending more time with their ‘residents’ than any other healthcare professional – which means knowing the small pains and pleasures better than anyone – often more than family members. I tweeted to the world:  Day-to-day efforts may seem thankless work but for the PSW this goes with job satisfaction:   In Palliative care – with its emphasis on whole person comfort and whole person symptom management – these PSWs have learned to read their residents non-verbal language: often a factor in those with Dementia. PSWs form such lasting relationships with residents and their families that they often attend the funeral and keep in touch after a residents’ death.I wonder, with so many who are in their care at life’s end, how do they cope with deaths – do they call upon social workers, chaplains or bereavement counselors? The resounding answer is: “We get comfort from our colleagues – fellow PSWs: only another PSW can understand the relationship and loss.“ I was shocked...