Palliative Care - A Reflection

The past 3 weeks in palliative care has been an interesting experience. My original knowledge of palliative care was that it deals with end of life situations and involves lots of painkillers. Now I know that palliative care treats the patient and the family as a whole, physically, psychosocially and spiritually. Admissions for respite and symptom control play a big role in the whole picture as well. Painkillers, while an integral part of care, is by no means the only drug used.

It’s a very different world from all the other rotations I’ve been through so far. The aim is not to cure the patient but to ensure that s/he is as comfortable as possible during their remaining time alive. To that end a multidisciplinary team (and drugs of course) is essential and this is the first time I have noticed all the different teams functioning together as a unit. It is refreshing to see, after being bombarded so often that medicine is multidisciplinary, the different disciplines actually closely interacting instead of just leaving information for each other in the case notes.

After a while it really struck me how accurate it is to be empathic instead of sympathetic in this field. One simply cannot afford to be sympathetic and maintain his/her own sanity with all the grieving and, sometimes unchecked emotions that occur in this place. The fact that sometimes not saying anything and just listening is the best thing you can do for a patient or family member was reinforced as well.

The many quirks of the different staff members made me laugh on many an occasion. It never ceases to amaze me how sometimes, especially in this particular field, how a simple laugh can make you feel so much better. Everyone was friendly and accommodating, even if they were stressed from dealing with difficult patients, and made me feel a part of the unit.

I have had the opportunity to learn how to certify that a person is clinically dead: Check for pulse, heartbeat, respirations, breath sounds and look for dilated fixed pupils. Having never physically been in contact with a corpse before, I was surprised how cold the body was just hours after death and the how rigor feels like.

I've seen many cases of cancers, some kinder ones and some really aggressive ones. I've literally seen a walking corpse (omg how much more cachectic can someone get?), I've seen the terminal stage of a few patients (which tend to scare the heck out of their family members) and we had a patient with a really dysfunctional family.

Along the way I believe I have gained some knowledge on analgesics, sedatives and laxatives throughout my attachment as well. This will undoubtedly prove useful to me in the future.

It seems like 3 weeks is just about right to gain an idea of what palliative care is like as a profession. I am happy to have experienced something which I knew very little about just a month ago. It has helped broaden my knowledge and, I daresay, helped me grow a little as a human being.

Many thanks goes to Heath for helping me along the way, giving little tips on whatever and giving me work to do when I was bored :) Thanks also goes out to Rebecca for all her 'preaching' sessions (I love it how she ends all her teaching sessions with "OK, that's enough preaching for now.") which made me do homework and were of great help to me :)

Finally a decent temperature!
The last couple of weeks ++ have been quite uncomfortable with daily temperatures above 40 degrees. The worst experience was on Friday and was mostly due to the fact that the local public transport service insists on using buses which are old and un-air conditioned.

The temperature on Friday was bad at 43 degrees. The worse part was that the wind actually felt hotter than the ambient temperature so there was no relief outside at all. As I left the GP where I was posted to, I took the first bus back to the city which was an oversight on my part as the bus was one of those stated above. I opened the window next to my seat expecting that the increase in ventilation would help cool me down somewhat. I promptly closed the window when all it did was make it even more unbearable. So there I was in the bus, feeling I was being slow-cooked as it went through the stops and traffic lights. I have never been more relieved to get off a bus in my life.

I've learnt my lesson. Next time I'm waiting for an airconditioned bus no matter what. I'm looking forward to the coming week just because it's forecasted to be below 30 degrees for all days except one.

The current weather in Adelaide kills. Literally. Today's news said that this year reported the highest incidences of sudden deaths during the heatwave although authorities have yet to reveal the true causes of deaths.

The daily temperature has been above 40 degrees Celsius for the last week and is forecast to remain there until the coming Friday where it's supposed to be 35. Couple of days ago recorded a high of 47 degrees! The heat has also caused trouble with the power generators resulting in certain areas (thankfully not mine) having no power supply for 2 nights. Pity the poor souls who had to survive in such situations.

There were also a bunch of people who braved (or imo were crazy)the heat in the Wayville showgrounds to catch some band performing. According to the news the band prepared for this heat by practicing in saunas and such. The authorities did their best to prevent adverse situations by spraying the crowd with water, providing water supplies to the masses and providing 'misting chambers' where they could go cool off. One interesting bit that caught my attention was this (imo) insane white guy who absolutely adored the heat and said to "turn it up to 50(degrees)" followed by a "Whooooooo!!!"

On a side note, weighed myself a few days back and was surprised to find myself weighing 73kgs now. The summer hols back home really did a number on me I guess. Will make myself lose them extra adiposities once this bloody heatwave is over.

Random Updated Updates

I'm seeing a lot of asses lately.

Surgery is not as bad as I thought it would be...but that's probably cuz my skin condition is much better than last year.

I've seen an operation which lasts less than 5 minutes.

I've seen an eyebrow-raising toe amputation.

I still wonder how (some) diabetics with foot ulcers don't seem particularly concerned about them.

I've seen a bad case of cellulitis with a weird-ish development.

I've been encouraged by a theatre nurse, telling me that my student life will fly past *snaps her fingers for emphasis* and then I'll join the workforce and have no life :) Concurrently wondering how much more 'no life' a person who already has no life can get.

I've had my name tested as various incarnations by the consultant in theatre. Problem was that the scrub nurse's name was also Ken. There was Ken, Ken1 (or 2...can't remember which), student Ken, and my personal favourite - Unpaid Ken :D

Wake Up

My energy levels seem to be going on a sine wave-like period. Just last week I was overcome by an unbearable desire to sleep. Anyone who knows me fairly well would probably know that I think sleeping, if it were not a requirement for life, is a waste of time. That, and the fact that my circadian rhythm wakes me up if my alarm doesn't, make me unable to have long lie-ins normally. I can't understand how some people, my cousins included, can sleep so much and frankly, sometimes I envy them. Anyway this came as a surprise to me, to say the least.

So on the first energyless day, I woke up and attempted to have breakfast as per usual. Now normally I'd managed to go through most of my morning bleary eyed and would properly wake up when I had to walk to the hospital. That morning my eyelids felt like they were tied to 10kg weights and a haze of tiredness clouded whatever thoughts I might have had. The only thing I could think of was sleep so I managed to stuff whatever remained of my breakfast down my throat and set my clock for another 15-20 mins of zzzs. Imagine my surprise when I woke up to find that it was already past 1230. So made myself some lunch and then felt sleepy again (which is normal for me). So I decided to have a power nap...which works more often than not for me...only that I woke up refreshed...at 1600++. At this point I was seriously considering that there was something wrong with me.

With all that sleep already having been slept off I thought I could actually study well that night. Well my body was obviously trying to prove me wrong as I was dozing off again at about 2230...and woke up 11 hours later. Most of the rest of the week I could function with my normal amounts of sleep but fatigue was my constant companion and he wasn't really fun to be with.

Friday came and I thought to myself, finally the weekend. I can have a lie in and begone with this fatigue business. That was the night I was cursing Murphy and his stupid law. I couldn't sleep!! I needed sleep - all the cells in my body knew it - but I just couldn't sleep! It was definitely one of the most annoying things in my life so far, even superseding that which annoys me most usually.

This wasn't the first time but it was definitely the worst. Had a less severe episode almost a month back and am pretty sure I've had at least one other episode sometime earlier in the year.
I'm guessing either respiratory or gastro bugs cuz I've had concurrent problems with both this time round. Whatever it is, I'm glad I'm finally over it...or at least I think I am. Who knows? Murphy has proven me wrong time and again...

Drum Tao

Just returned from a solo venture into the field of performing arts and I absolutely loved it!

Drum Tao - Martial Art of the Wadaiko

I chanced upon the advertising poster a few weeks ago and was instantly tempted, mostly by the opportunity to experience some new type of music. I asked around but nobody else seemed interested in it so I went solo. I was blown away by the performance. It was, quite frankly, one of the best things I've seen. Instruments aside, there were lots of shouts, leaps and amazing choreography to boot...and a couple of impressive-looking bo twirling sessions too.


As the title says, wadaiko were the main instruments of the night. However, to my pleasant surprise they included flutes, gongs, gu-zheng like instruments, xylophone-like instruments and monotonous trumpets (which looked like toilet plungers from where I was sitting) to great effect.
I particularly enjoyed a few of their bittersweet numbers. However, most of them were explosive, entrancing, addictive and energetic. It was so obvious that the performers were putting their all into their acts and they were enjoying it too. So much so that one could feel the energy influencing the audience.

The male performers demonstrated inhuman strength, dexterity and stamina with their drumming. On more than one occasion the drummers were beating so hard, so fast and for so long that I felt my arms ache. The choreography was exciting, sometimes mesmerizing and sometimes downright humourous. I'm not surprised that they've gotten amazing reviews (including 2 standing ovations) where they have performed. They definitely got a standing ovation from us tonight.

After tonight, I have a whole new appreciation for the drum. Kudos to you men and ladies for putting on such a great show.

Hontou ni arigatou gozaimasu.

If you get the chance to catch them, do so. You won't regret it!

Edit: Today (29/7/08) we broke our record. There were no patients on the ward for our team :) We were grinning away at handover while everyone else just stared at us in disbelief...or it could have been jealousy or hatred. It's hard to tell really :D

Went to hospital as usual today (28/7/08) and discovered that my team had all of...1 patient. Ward round consisted of us going to his bedside and attempting to wake him:

Reg: Mr X...*pats his hand*...Mr X?
Mr X: *grunt*
Reg: *shrugs* Well, Ken, that's our ward round :)
Reg+Intern+Me: *Lol*

For the record, Mr X needed some sedation the night before as he was somewhat agitated with altered sleeping patterns.

This must be some kind of record. I've never had a medical rotation with only 1 patient in the ward.