Palliative Care

I just watched a recording of the Four Corners programme on palliative care by Deb Masters (A Good Death) and, as I so often do, sat there nodding frequently in agreement with the views expressed.

Since my hospitalisations I am now always fascinated by decent medical stories, and this one was a great start for Four Corners for 2010.  In it we were shown, first-hand, the stories behind four people's final days on this earth.  All of them had cancer (two of them bowel cancer, one pancreatic and one breast).  In all cases the cancer had metastisised (spread) to many other organs.  They were fortunate in one regard in that they knew death was approaching.

The show posed more questions than it answered, of course.  There are not many places in the country setup for dieing.  Accute care and intensive care beds is where it probably happens the most, however they are not ideal places in which to die.  I can assure you of that from experience.  The palliative care ward at St Vincent's hospital in Sydney tries to provide such a place.  It makes sense spiritually and economically as well - it costs $3,000 - $4,000 per day  for an ICU bed, whereas a palliative care bed is from $600 - $1600 daily.

I nodded emphatically with Darryl Calver's comment "...I don't care what it is I have to take, legal or otherwise, [to] stop the pains so that I can go out and enjoy my last 18 months".  It might seem strange, but I know exactly what he means.

I nodded again at Sandy Riches's comment "It's mental anguish, you wake up every morning and you think 'I'm still here you beaut' ".  I can remember poor old Bev in the bed opposite me at Royal North Shore for nearly 7 weeks saying exactly the same thing.

And I nodded probably most emphatically at a comment from one of John Peart's relatives: "Dad saw his dad go through it and Dad was always strong about euthanasia but obviously it's illegal but his theory was that if you're in that much pain then you shouldn't be sitting there suffering"

It is pathetic that in this country and most others, you'd be prosecuted for being cruel to a pet if it was in constant pain and not euthanised, but as soon as the victim is human, the option is simply not available.  In fact we frequently see people assisting others in suicide charged with murder in this country.  There is a BIG difference between assisting suicide and murdering someone.  A murder victim generally does NOT want to die.  Someone wanting to commit suicide generally does.  However our legal system doesn't make any distinction.

When I was in RNS last year a woman in a bed diagonally opposite me was diagnosed with terminal gastrointestinal cancer.  The curtains were drawn to give her a semblance of privacy, but I could hear what the doctors were saying quite well through the thin drapes.  They were suggesting she needed operations and chemotherapy and so on, but she simply said to them that she wanted NO treatment.  She was even refusing regular medications as the nurses came around, and to the nurses' credit, they were complying with her requests, not trying to force her to take medications she didn't want.

She justified it to her sons (one of whom had flown over, taking time off from his relatively important job in the USA, the other was an Associate Professor of Marketing at a local uni) that she'd had a good life already and given that death was inevitable anyway, she didn't want to die with tubes stuck in her and weak from the chemotherapy.  I know that this choice is not what the sons wanted, but it was what this brave woman was insisting on, and I hope she got it.  It wouldn't have been my choice, I can assure you, but given that it was what she wanted with no doubt about it, I felt strongly about her right to make that choice and have her wishes fulfilled.

I never saw the conclusion to this, as they insisted she was transferred to RNS Private Hospital instead of the public one.  Mind you the nurse to patient ratio in a private hospital is generally WORSE than in a public hospital anyway, so it may not have been the best move.  A transfer to the St Vincent's palliative ward might have been in her best interest, having seen this Four Corners programme.

I just hope that when I am facing death I can be as courageous as this grand lady.  I think the victim is better off to deal with it than the relatives anyway.  When I was told I had a 20% chance of dieing last year I was grateful for the honest appraisal, and accepting of the fate.  After all, there was nothing I could do about it.  However I saw the effect it had on my wife and parents and it was not a pretty sight.  It's harder on the carers than the victims.  Perhaps that's a topic for a future programme - support not only for the afflicted, but also the relatives.