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.