By Sinéad Donnelly
A palliative medicine physician colleague of mine asked an audience of physicians where they would like to die: at home, hospice, or hospital? Sitting in the audience I can only remember the number in favour of the third option. One person — and that was me.
If a child can be born in a stable, I guess I can die in a hospital. With 22 years experience of palliative medicine, hospital does not seem to me like the worst place to die. More than anything, I want someone to care for me and about me, and the first line in my advanced care directive will make this preference clear. Then I may add that I don’t want to be on a Care Pathway to Anywhere. I don’t want nurses and doctors to say I had one “variant” last night according to the protocol but instead talk about me as a human being with pain or nausea or anxiety or comfortable, at peace, tearful, whatever. Don’t distance yourselves from me and the reality of my dying, a reality that you too will share one day. By the way, I don’t actually want to die. That’s another story.
If you really want my opinion about acronyms (and this is an opinion blog), one more abbreviation might well be the death of me. I don’t want an ANP asking about my ACP before putting me on the LCP.
A patient dying in hospital should be an honoured guest in an honoured place. What a novel concept! This idea is adapted from an inspiring essay by Ken Warpole. Commissioned by the Irish Hospice Foundation in 2005, Warpole reviewed the architecture and design of the hospital spaces in which the dying find themselves. The idea of hospital being an honoured place with dying patients as honoured guests opens a new window into our daily reality of working in hospitals.
The Royal College of Physicians in 2012 cautioned against the introduction of tools for the care of dying without an extensive programme of education and support to hospital staff. They discouraged the counterproductive tick-box approach to care of the dying patient. More recent literature points to a need to look at our behaviour towards dying patients, their families, and our colleagues. In addition to resources such as pathways or protocols, we need to pose new questions about hospital care of the dying patient:
- How do we behave towards other people within the hospital environment?
- How do staff members show that they care for the dying patient and grieving family?
- How can we make time for the dying patient and family?
- How can senior doctors and nurses show leadership and model compassionate and competent behaviour?
- How do we support our less experienced staff and colleagues in the face of dying and death in hospital?
Let’s imagine that I am the dying person in hospital. Imagine that you as hospital staff believe and know that you work in an honoured place. Let’s imagine that I feel like an honoured guest, that you make me feel like an honoured guest. Can we imagine how that might be?
Dr Sinéad Donnelly is a Consultant in Palliative Medicine at Wellington Regional Hospital, New Zealand. Her article, ‘Patient dying in hospital: an honoured guest in an honoured place?‘ appears in QJM: An International Journal of Medicine.
QJM is a long-established, leading general medical journal. It focuses on internal medicine and publishes peer-reviewed articles which promote medical science and practice. Published monthly, QJM includes original papers, editorials, reviews, commentary papers to air controversial issues, and a correspondence column.