Every Second Counts

I'm two weeks into my fifth year of medical school. Yep, just like that. I would say that there is no rest for the wicked but actually I have been lucky to have an awful lot of time to do the things I've wanted to over the last few weeks. 

The highlight to eclipse all others this month has got to be Alex & Holly's wedding. Beautiful day. Beautiful couple. Beautiful emotions! I'm not sure a summary of the day or of them as a couple can do justice but I'll try and give a brief overview; for one thing, I'm sure they wouldn't want me to ramble on about them! (Luckily I'm fairly certain they don't read this, so I can probably say what I want). 

Firstly, one of the reasons this was such an incredible moment was that Alex is like a brother; we've been friends for 9 years and when I look back on our friendship I realise just how much time we spent together. He became part of the family, really, and one of the lovely things about that is the closeness that gave us with his real family, such as his sister: 

Sarah is awesome! 

Secondly, and probably the most important thing about the day, Alex got married to the most wonderful woman. Yep, Alex is great so perhaps it's to be expected that he would marry someone equally wonderful - but he didn't - Holly is actually even better! 

 It was a huge honour to be there to share in the day when this couple got their act started their lives together. 

 

The world is beautiful and life is so precious. If there is one thing I've realised during these past few weeks it's how precious every second is. You absolutely have to savour the good times and be grateful for them because of how lucky it makes you to have those moments.

 

Why have I come to this understanding? For the last two weeks I've been on a Palliative Care rotation. Now, I know what this might mean to some people and so I want to give a bit of an explanation so it gets a fair hearing. Palliative Care is very often seen as being a negative thing because of the association with death and dying.  While it is true that Palliative Care physicians are involved at the last stages of peoples' lives they are neither the servants of the grim reaper nor are they like the Fates from Hercules that stand with the thread of your life stretched out in order to cut it in a timely fashion. However, they aren't heroes that come galloping in to complex situations in order to provide long life and the waters from the fountain of youth. In fact, Palliation is not about increasing your time in this life or about shortening it; though, from my perspective I have to say that the excellent levels of care I've witnessed from devoted palliative care teams does seem to lean the balance toward the former.

 

This week has been a difficult one for a lot of palliative care health professionals. I was in a meeting this week where one of the nurses voiced the concern that the report damning the Liverpool Care Pathway was "starting a witch hunt" while another shakily stated that the media handling of the situation had made her feel that it was now being suggested that she and colleagues, who had used the Pathway, had killed people. A consultant told us that she had sent a card to the Liverpool Palliative Care Team to offer condolences. I also heard admissions that the teams have seen times when the LCP has been used incorrectly. Whatever your opinion or experiences, the professionals involved in this situation have had the best of intentions. It's awful for families that have had bad experiences with the pathway; but unfortunately I feel that there are always going to be things about the end of someone's life that doesn't go the way we would wish or expect. Human failings occur, miscommunications happen and ultimately injury is sometimes caused. It would be great if that wasn't the case. I hope, in the future, to look after patients and provide them with dignity at every stage of life.

 

So, if palliation isn't just about end of life care, what else is there to it? An easy way to illustrate this is to mention the three reasons that people go (as an inpatient - there are also day hospices) into a hospice:

1. End-of-life care- a person who is expected to have less than 2 weeks to live and who has expressed a wish to be in a hospice when the end comes.
2. Symptom control- a person with a disease that is terminal (i.e. it is likely to be their cause of death) that is causing symptoms that are difficult to control at home. Examples are: pain, nausea, constipation, breathlessness... really, it can be anything.
3. Respite- a person who has a disease that is terminal who comes into the hospice for 1-2 weeks to gain some rest and generally be taken care of to allow the family/carers time to do the same.

I've heard of situations in which the family either refuses to use the word "hospice" or "palliative" to a relative; or wants to quickly chase away the palliative physicians claiming "I'm not there yet!!!" when, actually, the physicians have access to resources which could vastly improve the quality of their life!

I realise I have gone off on one and some of you are probably thinking, "WOAH! I saw pretty pictures and thought I might like to have a scan read! I don't want to hear about death!"

Well, why not?

It's as much a part of your life as being born. Neither are events that you particularly remember or that seem to affect who you are very much despite the major impact they have on you. In fact, of the three events significant enough for us to register there is only one that we, ourselves, remember. And that is marriage. Which links us neatly with the subject I began on. You see, there is method to my madness!

And the quote that constantly runs through my head that ties these two together?

"We're so arrogant, aren't we?

So afraid of age, we do everything we can to prevent it.

We don't realize what a privilege it is to grow old with someone."

- P.S. I Love You

 

I feel like I've seen it all this week. I've seen young love leading to a deep and lasting commitment. I've seen people who come to the end of life content with their lot, however long or short, happy to leave this mortal coil when they are called. I've seen those who fight against old age; and those who accept it. I've seen children who are on the brink of losing parents. I've met parents who've said goodbye to a beloved child.

 

Every Second Counts. It really does. There are so many things that we don't have a choice over in this life and sometimes birth and death don't really come with the dignity and reverence that we feel intrinsically should be theirs. But, it's the bit in between that matters the most. It's what we do with that bit that allows us a deep dignity within our very souls that cannot and will not be removed. Those are the moments where we have the opportunity to accomplish the things we will be remembered for.