A good death.

I am off work with tonsillitis and it makes for a slightly drugged and complative me.

A big part of what I love about my job has always been palliative care, care of the terminally ill and dying.
This may seem a little counterintuitive for a nurse to say. I mean, we’re healers right? Here to mend and assist and care and fix?
Well, part of what I love about being a nurse more than, say, a doctor, is that nursing makes a space for the failure of medicine.
I should maybe elaborate a little.

One of the really nice things about doctors is that drive that most have to save, rescue, fix their patient. One of the really irritating things about doctors is that sometimes that is the SINGLE MOST IMPORTANT THING IN THE WORLD. For most nurses, the wellbeing of their patient is the most important thing. This is where you encounter many of the classic Dr vs. Nurse throw downs in the world of healthcare. Sometimes, the best thing for the patient is not the best thing for the patient’s health or recovery.

Sometimes the patient is better at accepting that death is inevitable than their doctor is.

I personally have had a few, well, not fights exactly but certainly impassioned conversations with doctors who, with the patient foremost in their mind, have requested scans or invasive procedures for someone who is clearly dying and would be made uncomfortable by the requested activity. It is a constant reassurance to me that these conversations have always been based around what is best for the patient, not around what the staff members involved want. However, just getting someone put onto the Liverpool Care pathway can be a struggle in itself sometimes. As if admitting that a patient is dying is admitting some form of defeat.

It is a generalisation that I am happy to make, however, that doctors will fight until the last breath to keep a patient alive whereas nurses focus more on comfort and pain relief than prolonging life. It’s almost a quantity vs. quality prioritisation.

Out in ‘the community’ things work differently. When someone is dying in their own home they have generally been through all of the active treatments and there is an agreement that medical input is based on palliative needs. The really rather excellent frameworks that the NHS as a a national organisation works so hard at putting in place get used correctly and people get the support that they need.

Previous to working in a hospital, I was a community nurse… district nursing in the old parlance. I looked after people in their own homes who were unable to attend their GP surgery or required specialised care. I loved my job, I mean PROPER loved it.

There is a level of privilege and insight that comes with being allowed into someone’s home to provide care for them that just can’t be equalled by nursing someone in the hospital environment. A large part of what the district nursing teams across the country do day and night is care of the dying. Symptom control with drug administration, supporting the family of the patient and organising equipment and assistance to make those final hours, days or weeks as stress-free and pleasant as possible.

It’s a really good death 9 times out of 10 and, in my experience, nearly always more comfortable and settled for the patient and their family than an expected death in hospital. There’s something about being surrounded by familiar smells, sounds and objects that can’t be equalled by a hospital environment

I really have been hugely privileged to be able to help many of my patients experience a good death, and to be able to provide the support as best I can for their family members. As a professional, I’ve been supported in this by some amazing organisations who provide invaluable information and services for healthcare workers, patients and family members alike.

Anyway, I’m not sure what made me thoughtful about this today. Sometimes I’m really proud of what I do as a job and what the NHS does without fuss or fanfare as an organisation. Today was just one of those days.

Maybe the next time that someone badmouths the NHS and is focusing only on the few hours they had to wait to be seen in an A&E department, they’ll stop and think about all of the people all over the country working in and out of hospitals to make sure that you avoid that death until your time really is up. I hope that when that time comes, there’s still a free service staffed by passionate people to make it the best possible death it can be.

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One Response to A good death.

  1. Pingback: Suicide is painful. « Rants of a Skeptical Nurse.

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