My tribe

• I’m now finished my palliative care elective at Victoria Hospice. It was awesome. I had a conversation with one of the physicians on Friday who told me about her experience of stumbling into palliative care and when she did, feeling like she’d found her “tribe”. Being surrounded by people that shared the same values, beliefs, priorities and just “got it”. I must say that I felt the same way, although I have had some good connections with family doctors too but the style of their day differs significantly. Anyway, it was a great experience and I’m hoping to do more with a recent application to do a 2 week elective in Halifax in Palliative Care in February to try to avoid the zoo that will be Vancouver during the Olympics (where I’m currently scheduled to be for a nephrology elective).

• This week I went out with the Palliative Response Team one day to see what they do. That team consists of a nurse and counsellor who can be called on by the family or the home care nurse to come and help when things are getting out of control for a family with a loved one dying at home – out of control emotionally or a pain/symptom crisis. It was pretty cool to see them at work. That day, I also really saw the difference a good family doctor makes. One family’s doctor didn’t make house calls and was pretty much unavailable after hours for changes to orders of pain medication or other things. And he was stingy with pain meds (which is really unfortunate in the case of a dying patient who has escalating pain). The other family’s doctor was very accessible, giving them his cellphone number and calling a couple times each day to check in. He obviously cared about the family and providing good patient care. What a difference it made. The first family basically felt abandoned by their doctor and if anything, he was an impediment to good care. The nurses sometimes end up doing things like waiting til a lunch break or some time when such unhelpful docs are unavailable to call for medication orders so that they could end up calling the palliative care docs instead with the excuse that the family doc is unavailable. It's easy to sit in an office and think about how you'd prefer to not do call or house calls etc. It's entirely another experience to be in a patient's home and see the difference it makes.

• I had an good conversation on Thursday afternoon with the spiritual care counsellor as I was curious how he kicks off conversations with people and whether he tells them what they want to hear or what he believes is true. It was really interesting and it sounds like “counsellor” is quite a fitting term in his title because he described turning questions back to people in the way that counsellors do, since people often have their own answers. When someone asks him for instance if he thinks they’ll be reunited with their wife when they die, he’ll ask them what they think and take the conversation from there. Anyway, he seems like a wise and open man. He cracked me up by saying that for some people, talking about spirituality is like trying to get a 40 year old man to talk about his feelings – sometimes they just don’t have the vocabulary to know where to start. So he said he’s slowly building up a vocabulary that is non-denominational (he’s an Anglican minister) to try to help people have the discussions that they want and need to have as they approach the end of their life. Fascinating. And wonderful that learning about what he does and how he fits into the mix is included as part of this experience. Another reason why I found palliative care to be really wonderful.

• Anyway, I start family practice tomorrow which will be a good review and a bit of an “into the fire” experience after so long away from it (summer ’08!). It’s shaping up to be a busy one with a morning flu shot clinic (out out damn H1N1) and an evening clinic on Tuesday night and a call shift to boot! I’ll keep you posted.