PALLIATIVE CARE II

A large, Victorian manor, Mount Pleasant Hospice rose from its surroundings, dwarfing everything else in sight – the jewel in a rural crown.  Pulling into the winding drive that snaked across the grassland leading to the main building, we passed rows of hedges separating the establishment from the rest of the world.  There were manicured flowerbeds displaying all colours of the visible spectrum, populated by all manner of creatures, the entire scene bathed in golden sunlight.  The only object out of place was a black bin of rocksalt that stood proudly by the main gates.  SALT, it read, in bold white lettering.

“As NHS budget cuts become increasingly severe, the Speech And Language Therapists are forced to relocate to a smaller office”, I smirked in my best impression of a newsreader while gesturing towards the bin.  Nobody would even part with a sympathy laugh.  I shrugged, “Well I thought it was funny”.

Inside the hospice, there was not the usual stench of disinfectant with undertones if piss and sweat that so often lingers in nursing homes and other such places.  A grand entrance gave way to a brilliantly illuminated reception area complete with glass walls revealing an inner courtyard where topiary and water features fought for space.  Situated to the right of the reception were a set of luxurious sofas, and past those were the doctors’ office and ultimately the corridor leading to the rooms of the patients residing in the hospice.

“Wow, imagine dying here – it would be great!”.  Still nothing.  Tough crowd.

The first task of the day was to practice taking a history from palliative patients, hopefully something simple enough after the past few weeks of placement.

“Mr Singleton is in Room 13, he would probably be interesting to have a chat with”, a nurse informed us.

“I’ll take this one,” I said already strolling away, notepad and pen in naïve, arrogant hand.

Martin had been in the hospice for some time now, and unfortunately, he was dying.  His prostate cancer had spread to his bones and he was now confined to a chair until the end of his days.  Unsurprisingly, this had left him anhedonic in the extreme and all but robbed him of his will to live.  What was most striking about Martin was the sense of loneliness that he emanated.  Despite the occasional visit from his partner, he spent much of his time alone and seemed grateful to have the opportunity to interact with another human, if only for a short while.

While we spoke he told stories from his youth.  Of how he and his father would search for rare coins on the beach with their metal detectors and occasionally discover artefacts from a bygone era.  He recounted his days in the military and the evenings spent smoking cigarettes watching the North African sunset, and eventually he told of his devastation at the passing of his brother and the difficulties of coming to terms with his illness.  Exacerbating his despair was the fact that other than his hip pain and fatigue, he was completely well with no other symptoms or ailments of any shape or form.  None whatsoever.

Leaving the room I felt a sense of fulfilment.  This man had taken the time to pour his heart out, to create a window into his past, present and future and most heart-warming of all, our conversation seemed to have brightened his day, a precious sentiment considering it was likely that he had few left.

The second and final task of the day was to present this case at the MDT meeting.  Again, nothing too daunting after previous experience on this placement pathway.

Martin was the final patient on the list and as soon as his details appeared on the board at the head of the table, something about Martin became abundantly clear – Martin was a fucking arsehole.

Not only did he have an extensive list of other symptoms that he had failed to disclose making it incredibly difficult to piece his case together, but he had also decided to spend his life savings on a speedboat which he was unable to use placing the financial burden for his care solely onto his partner, a gentleman twenty years his junior already struggling to balance his professional commitments and caring for Martin.  Not to mention the fact that he had never served in the forces, despite flaunting this deception like a medal of honour with complete indifference for all those that have fought and died to be able to claim such an achievement.  His exploits, in combination with a total disregard for the advice of the hospice staff, meant that he had established quite the reputation.

All this aside, a useful lesson had been learnt.  Not all patients are arseholes, but some of them certainly are, and one of the things that sets apart the outstanding clinicians from the good ones is a startling ability to genuinely care about them regardless.

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