Defining Palliative Care

This blog post entitled, "Palliative care needs a simple and consistent message"  at KevinMD.com is worth reading.

Shell Shock

"Six weeks ago I felt fine". Today, I have two different kinds of cancer, one on my vocal cord making my voice hoarse and one in my lung pressing on my blood vessels, making me feel short of breath and causing my face and arms to swell. The lung cancer has already spread to my bones. My legs are weak. Now I need a brace and a walker to walk and my back hurts. If I try to walk, I get more short of breath. My pancreas is inflamed and they say I have diabetes. I can't sleep because I am worried. What happened??? 
I included the words "shell shock" on the Palliative Medicine consult today, amidst the obvious issues of pain, shortness of breath.... The term was first coined in WWI to describe the confused or nervous mental condition of people who had been under fire in a war. Today, "shell-shocked" is also used to describe someone in a state of stunned confusion or shock; someone who is dazed. The signs of shell shock are disorientation and inability to focus, with reactions like shaking, nightmares, twitching, headaches, fatigue, insomnia, dizziness, anxiety, and irritability. These are also signs experienced by patients with life-limiting illnesses who develop, for example, opioid neurotoxicity or delerium. In this case though, it was simply too much, too soon, too life-altering.

der Philosoph

The title of Haydn's Symphony #22, "The Philosopher", is thought to derive from the interplay in the first movement between the strings and English horns (melody and counterpoint), simulating a question followed by an answer. The composition evokes the image of a philosopher deep in thought while time passes (alluded to musically by the muted tick-tock effect). This symphony comes to mind every now and then when I find myself contemplating alternatives & having to make a decision .... trying to strike a balance between intuition (being/receiving) and reason (doing/thinking). Other balance images include the seal totem and the Third eye chakra
EMI Classics: Simon Rattle & The City of Birmingham Orchestra
I Adagio
II Presto
III Menuetto & TrioIV Finale (Presto)

Wordles & Endless Possibilities

This wonderful site offers endless possibilities for creative expression using words. The developer says: "Wordle is a toy for generating “word clouds” from text that you provide. The clouds give greater prominence to words that appear more frequently in the source text. You can tweak your clouds with different fonts, layouts, and color schemes".
This wordle was created from the blog post entitled, "Is there a difference between the soul and the spirit?", March 28th.

It would be interesting to monitor ongoing symptom burden in selected patients by teaching them how to use this tool. A visual ESAS! with choice of font, color scheme and layout. On the web site, under the Wordle 'advanced' tab, words can be weighted to increase their prominence. Here is an example using ESAS symptoms with weights arbitrarily assigned, giving anxiety the highest symptom burden and appetite, breathlessness and nausea the lowest: Pain:60, Depression:20, Nausea:10, Mood:20, Sleep:80, Tiredness:80, Anxiety:100, Well-being:50, Breathlessness:10, Appetite:10. It is easy to see that anxiety is the main issue confronting this fictitious patient, followed by tiredness and sleep.

This wordle uses 'duality' font, the 'mostly horizontal' layout and the 'kindled' color scheme. It is possible to select specific colors for each word if one understands how to use HTML color names. The wordle product changes every time you make a selection.....so, if you create something beautiful, open it in window (see tab on bottom left of the wordle), then save it as a screen shot.

Specialist Palliative Care Services

Teleman Suite in B flat major TWV 55:B10 

At rounds this week, members of our team were lamenting the confused response they sometimes encounter from patients when they announce they are from the Palliative Care team. 

"I must be dying"

"You mean there is no more hope"

"Have they given up on me?"

Similarly, we receive consults asking for "End of Life orders" when our presence earlier in the course of the patient's illness would have been helpful. 

The World Health Organization calls palliative care "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness." The illness might be cancer, but increasingly the term palliative care is used in regard to conditions such as renal disease, chronic heart failure, HIV/AIDS, progressive lung disorders and neurological conditions.  It is active holistic care. For this reason, the care team includes palliative medicine consultants and palliative care nurse specialists together with a range of expertise provided by social workers, physiotherapists, occupational therapists, dieticians, pharmacists and those able to give spiritual and psychological support. It is a sharing partnership between the person with the illness, their family and friends, the surrounding community and members of the health care team to re-frame hope, provide meticulous pain and symptom management and offer supportive care for the purpose of helping those involved cope with the condition and it's treatment, from diagnosis to cure or, through continuing illness to death and into bereavement.

The goal of palliative care is not dying, it is living each remaining day of life as fully as possible.

Gratitude

 









 
I see trees of green, red roses too
I see them bloom, for me and you
And I think to myself, what a wonderful world.
I see skies of blue, and clouds of white
The bright blessed day, the dark sacred night
And I think to myself, what a wonderful world.
The colors of the rainbow, so pretty in the sky
Are also on the faces, of people going by
I see friends shaking hands, saying how do you do
They're really saying, I love you.
I hear babies cry, I watch them grow
They'll learn much more, than I'll never know
And I think to myself, what a wonderful world
Yes I think to myself, what a wonderful world.
Oh yeah...

Are You at Peace?

"Are you at peace?" is an opening "probing" question used to gently broach the topic of existential distress. What is the comeback when the answer is a resounding NO!?

Care Search categorizes existential distress as relating to loss of control, burden on others, relationship related concerns, loss of continuity, uncompleted life task, hope / hopelessness, and acceptance / preparation. The Japanese Spiritual Care Task Force suggests psycho-existential suffering is caused by the loss of three essential components:

• Loss of relationships (with others) 
• Loss of autonomy (independence, control over future, continuity of self)
• Loss of temporality (the future)

Today I witnessed it as someone no longer able to touch/access that which used to ignite his internal spark. In this case it was math puzzles. Usual efforts to connect with what previously provided the dual power to energize and comfort failed and these had now become a source of distress, a reminder of the uninvited effects of disease and medication on the mind.

What "brings us to life", energizes & animates are the aspects of self that are precious to the individual. When you are sorrowful, look... in your heart and you shall see that... you are weeping for that which has been your delight. Kahlil Gabrin