World Hospice and Palliative Care Day

Friday, October 12th was the global World Hospice and Palliative Care Day. I don’t imagine you heard much about it in the news, did you? I’m not exactly surprised by this, but it does dishearten me a bit. Now granted, you can find a ‘day’ dedicated to just about anything (there’s even a National Peanut Butter and Jelly day), so in some ways I understand why another ‘day’ didn’t make huge headlines. But the fact is that not nearly enough attention is paid to the importance of hospice and palliative care in the media, and I think any opportunity to do so should be taken.

I think the crux of the issue as to why the day went under so many people’s radar is that as a society, we tend to cringe at the sound of words like ‘hospice’ and ‘palliative’. We view the end of life as something to dread, and we’re fearful of anything associated with it—many find it upsetting. We have been conditioned to think of only the negative aspects surrounding the end of a life.

Hospice and palliative care are about celebrating the life that was and is. And while we must mourn and grieve, we do no honour to our loved ones by failing to acknowledge everything that their life was. The end of life should find one surrounded by love and joy, not misery. And so World Hospice and Palliative Care Day is not about a day of sadness, but a day where we recognize that every life lived deserves an ending filled with beauty, love, and peace.

Death and dying in many languages…

A few weeks back I talked about meditation and how its beauty lay in the fact that it required no specific spiritual orientation—it’s open to people of all religious or even non-religious backgrounds. As a result, it’s something I think can benefit both patients and practitioners in palliative care.

But I thought it would also be interesting to talk a bit about the flipside a non-denominational approach to care. Because despite the fact that I don’t generally consider myself to be a religious person (spiritual yes, religious no), the reality is that working in the palliative setting I’m going to be encountering people from an incredible variety of backgrounds.

One of the greatest challenges we face in the hospital setting is how best to serve the needs of patients and families who come from cultural and ethnic backgrounds different from our own. Obviously the most obvious challenge is that of communication—people for whom English is not their first language may find it challenging to convey their wishes to us. And we need to take time to ensure that we’re ‘speaking the same language’ both figuratively and literally (different phrases and words may have very different meanings in different languages).

But beyond that, it’s important to try and understand how differing cultural backgrounds can greatly influence how people understand and cope with death and dying. In medicine we refer to it as ‘cultural competency’, and it’s where the art and science of medicine meet. Depending on a person’s background they may approach end-of-life issues in a manner that is dramatically different than our own—and it’s my job to try and not only understand how that shapes their understanding of the situation, but also to communicate in a way that is sensitive to that background.

It’s something that we as practitioners struggle with on a daily basis, and an area of palliative care that can always use more research and discussion. And it’s also one of the reasons I feel so fortunate to have been able to participate in the Upaya program where I was able to deepen my own relationship with death and dying by understanding the approaches of others.

 

 

Ensuring quality palliative care for all

A new article on end-of-life care was recently published in the CMAJ, talking about the need to create a national system of standardization for palliative healthcare delivery. I found it really fascinating on a number of levels, and it’s certainly a discussion that needs to be had.

Because there is no effective regulatory system governing palliative or home care in Canada, essentially anyone can set up a business providing these services—they don’t need to be a medical practitioner or have any medical training whatsoever because accreditation is voluntary (one of the few exceptions is found in Quebec).

Now obviously, this sets up a very dangerous situation and sadly, has resulted in numerous cases of injury, and abuse. What especially bothers me about the situation is that this means that there are people out there treating end-of-life care as though it were just another service-based business, like window washing. As a result, you get unqualified individuals providing sub-standard care to those who are most in need.

I’m glad to see that we’re having this discussion in the medical field—it’s an important one to have. And I hope as we move forward in ensuring the highest level of palliative are for patients, that we also include a broad variety of those involved in end-of-life issues. Let’s remember that expertise in this field isn’t derived solely from a medical degree.

 

 

 

Still learning after all these years…

So we’ve just hit the first official days of autumn, and by now students of all ages are firmly ensconced in their studies, whether that be at elementary or high school, university, or even preschool. The rush for school supplies those first weeks of school, seeing all the college students taking over cafes with their binders and textbooks, all of it reminds me of the real joy that is learning.

I think there’s a tendency to think that when we’re done our ‘official’ education programs—when we flip over our tassels and are handed our diplomas and what-have-yous—that the ‘learning’ part of our life is over. My profession is the perfect example of how far from reality that is.

Doctors, if they want to continue to be effective, are necessarily engaged in a process of life-long learning. Just think about it: new scientific breakthroughs, new approaches to our understanding of mind and body, new treatments are always appearing. And wouldn’t your doctor to be on the cutting edge of all that news and information? Of course you would! And the only way that happens is if they retain an active commitment to learning.

But I’m also referring to more informal learning as well. In palliative care we learn that one of the most important parts of our jobs is listening. There is absolutely no way you can be an effective palliative practitioner without listening to your patient; most of the work we do is dependent on being able to assess what they need from us.

And by listening I learn not only about how best to treat my patients, but I learn more about myself. Sure, by listening to patients you’ll learn about their symptoms and how best to manage their pain, but you’ll also learn more about the human experience by listening to their stories and experiences; I can’t imagine an education more valuable than that.

Meditating my way towards perspective

Ever since my time at Upaya, meditation has been playing an increasingly important role in my life. In fact, it’s an important part of the coping mechanisms to avoid stress and burn-out that I talked about a few weeks ago.

I’d taken a break from it for a little while, but recently a friend got me back into practicing it more regularly. She sent me this little blurb as a reminder why it had been so important to me to do in the first place:

12 symptoms of a spiritual awakening:

1.   An increased tendency to let things happen rather than making them happen.
2.   Frequent attacks of smiling.
3.   Feelings of being connected with others and nature.
4.   Frequently overwhelming episodes of appreciation.
5.   A tendency to think and act spontaneously rather out of fear based on past experience.
6.   An unmistakable ability to enjoy each moment.
7.   A loss of the ability to worry.
8.   A loss of interest in conflict.
9.   A loss of interest in interpreting the actions of others.
10. A loss of interest in judging others.
11. A loss of interest in judging oneself.
12. Gaining the ability to love without expecting anything in return.

People sometimes get thrown off by the words “spiritual awakening,” but they needn’t be The beauty of meditation is that it requires no religious affiliation to be practiced.. In the context of meditation, it’s really just about achieving psychological balance, calm, and emotional and physical relaxation—what person couldn’t use more of those things their life?

And the benefits of meditation are countless both for medical practitioners and patients. Stress can have a serious negative impact on your health and it’s not to be taken lightly. Meditation can help provide you with the perspective needed to better cope with daily stresses.

With the autumn months come myriad changes and its easy to get bogged down with all the details. It’s the perfect time to embrace the opportunity for self-examination to the balance in our lives we all need and deserve.

Book now a reference for the Canadian Virtual Hospice

I just thought I would let you know that my book Dying in the Land of Enchantment has now been posted as a Tools for Practice with the Canadian Virtual Hospice.

You can read about it here http://bit.ly/P5QVQa

I have been using the Canadian Virtual Hospice as a reference for my colleagues and patients so it is quite an honour to have my book mentioned on their site.

Thanks to them for acknowledging my book!

What are you waiting for?

I spoke last week about the locum I spent this past month in Sarnia, and briefly mentioned how much I really like the opportunity to ‘slow things down’ by working in a smaller city. The reason why I find it so valuable is that I always walk away from these opportunities with a wealth of new experiences and lessons.

Upon spying my wedding ring, one of the patients in palliative care asked me my age and whether my partner and I had any children. When I answered ‘no’, and that I was 37, she quite bluntly asked me, “Well what are you waiting for? Get to it!”

I know we often hear these kinds of things from friends and family on a regular basis, but it’s easy for us to ignore it, or nod politely and just move the conversation on. But these comments become all the more poignant when you’re working in palliative care. Many out there are under the misapprehension that palliative care is just about easing suffering for the elderly at the end of their lives.

What they forget is how many, what we would consider ‘young’ people are found there as well. I am constantly reminded of how fleeting life can be, and how important it is to appreciate and celebrate that fact. And we do so through our deeds and actions. The most heart-breaking thing I encounter in my field is not when a life is lost—which of course is saddening—but when a patient is anguished over regrets they may have.

I have often said that palliative care is not so much about dying, as it is about living—about celebrating the life we’ve lived and those we have touched. Knowing that a life has been lived without regrets and to its fullest enables both the patient, and their loved ones, to approach the end with a certain amount of peace—peace that can be so critical to the grief process.

It may sound clichéd, but we all have a million reasons to put off doing something we want to do. Many of them may well be legitimate, and it serves no one to be bullied into making decisions we’re not ready to make. But in the end I think it boils down to this—if you or a loved one were reaching the end of your/their life, would you have any regrets?  I think the answer to that question serves as an invaluable life guide.