Golden value of palliative care, should be available for all
I am delighted ‘Ali’ has been moved to Australia where he will access much needed palliation.
The Guardian Dying refugee moved from Naaru
The intense campaign to bring this terminally ill refugee (lung cancer with brain metastasis) to Australia for palliative care was successful, thank goodness.
I want to share a story I wrote 8 years ago. When my brother in law was battling the same diagnosis and sadly passed away in May 2010. Our family knows well the importance of good palliative care and what a huge support trained professionals offer in such challenging times.
Uppal T
The House call
Writing by Creative Doctors
Published October 2010
‘A tragic loss’
Page36-37
Medical Observer
For Tashu and Hammoudi, in memory of their loving father.
THE HOUSE CALL
It is a windy afternoon.
A visit I have been dreading. Only because of the gorgeous baby there, with the most adorable eyelashes ever and a kilowatt smile. Happily ignorant of his father’s condition.
What a tragedy. What a waste of a young life. What an untimely death this is leading to.
My patient, James, is a 40 year-old man, though now he looks 60. He used to be full of charm. His eyes currently have an emotion that has no description. A combination of fear and regret. A loss of hope. It comes from knowing he may not even get to see his baby son walk.
This house call feels like an anti-smoking campaign advertisement.
So many memories come flooding back. He is not only my patient, he was also my friend. I have known him for about two decades now. I have seen him smoke and quit and smoke again. The cycle of death… it now seems to be.
“Nonsense, Uncle Justin smoked and he is 80,” and “I will quit… next month.”
Well, it is a Russian roulette really. Guess who got the turn with the loaded bullet?
Then there is his five year-old daughter. “When my daddy is better we will visit the Blue Mountains.”
I think… Does she understand the finality of death? Does she know that
she is losing her friend and her advocate? Who will take her on those evening drives? Who will fix her dollhouse when it breaks? What will her Father’s Day be like?
The words of the oncologist are ringing in his ears. “An aggressive form of lung cancer”, “Diagnosed from bony metastasis”. He was fit and well, really, till then… just a slight difficulty in walking… this has become a downward spiral now and there seem to be no brakes. Chemotherapy is leading to more misery than time gain. Hypercalcaemia is an issue that is proving a challenge – the reason for my house call today.
I think back to a few months ago. The weekend family and friends rendezvous. James’s loud voice telling an exaggerated story. The hum of merrymaking and children’s laughter. James cooking on the barbecue in the backyard. He made such succulent kebabs and chicken pieces.
My mouth waters and then I suddenly return to reality with a sinking feeling… A world of depression and pain. What pain can make a grown-up man sob like a child? It is said that bone pain is worse than labour pain. Too hard. Too sad. I stop outside the door and contemplate just going back to the surgery and referring him to another doctor.
Instead, I ring the bell.
It is opened by his wife, Anne. Holding the five month-old baby. It is the best example of courage I have encountered. Her family and friends have been her rocks, she tells me. Being a medical doctor has made the prognosis even more daunting for her. I wonder how difficult this is for her. She also has the five year old to steer through this complex and challenging time.
“Has she seen the oncology child counsellor?” I ask.
“She has, but I really don’t know how much she understands or has absorbed.”
She tells me the baby has been chesty and unwell. Sigh. The “normal” viral flus and colds still occur despite such a difficult crisis. A sick baby…Oh dear, how much more pear shaped could this situation become
“He wants to stay at home.”
I know the hoops Anne has jumped through to accommodate James’ request to spend more time in his home. I walk into the room that looks like more like a hospital ward with all the equipment, including an electric bed and wheelchair.
It does not feel right. It should not be happening. Not to such a previously dynamic and active man. Bursting with energy. This was the time to cherish his young family. To build happy memories. To reap the benefits of the countless hours of work put into building his career. To enjoy the home renovations he had just completed. To drive his new car. To travel the world. The tickets for the international trip planned before he was diagnosed were on the dining table. They would need to be returned. Shattered dreams.
Yes. Every cigarette is indeed doing you damage!!
Although smoking rates have dropped locally, there are still just under three million Australians who smoke every day. There is a tobacco-related death about every half an hour in Australia. That is what you eventually become: a statistic, a number, a vacuum your carers have to live with.
Here is a baby who will never meet his father. Here is a wife who will become a single mother in just four months.
I make a mental note to step up my Quit Smoking sermon to my future patients.
If only they could see a glimpse of the future. The pain of cancer. The lost opportunities. The grief of the family left behind. The fear of dying. The realisation that there is no going back to ‘unsmoke’.
IS IT REALLY WORTH IT?
(NSW)
SMOKING AND PREGNANCY
NSWHEALTH Info Smoking and Pregnancy
‘The national guidelines for smoking and pregnancy New Maternity Guidelines recommend that if a pregnant woman has tried to quit ‘cold turkey’ and has failed, she should be offered nicotine replacement therapy (NRT) to help control cravings and manage withdrawal symptoms.
NRT products (gum, lozenge, inhalator, patches and spray) do contain nicotine but at much lower levels than in cigarettes – and none of the other 7000 nasty chemicals found in cigarette smoke. This makes NRT less harmful to the baby than continuing to smoke.
If you are keen to try NRT to help with your quitting, it is important to be shown what products are available, how to use them correctly and what dosage to take. Ask your health professional (GP, midwife or smoking cessation advisor) to talk you through the NRT products available, or call the NSW Quitline 137878 for advice.’
‘Pregnancy is a time when women are the most motivated to stop smoking, with a 3.8-fold increase in smoking cessation rate when compared to non-pregnant women’ RANZCOG Statement Women and smoking
‘Nondisclosure of smoking in pregnancy is widespread. Disclosure is improved by asking “do you smoke the same as before you were pregnant?”, “do you smoke less since you found out you were pregnant?”, or “do you smoke occasionally?” compared to “do you smoke?”. Counselling, nicotine patches,and telephone support services have been shown to be effective in reducing the incidence of smoking’ RANZCOG STATEMENT Substanceabuse in pregnancy
