Have I got the latest list of meds? Did I remember Chris’ needle and insulin, his noon meds for the journey home? Has he taken his morning shot, his morning pills? Do I have the purse with the medicare cards, ID and any other necessary forms or documents? Did I get gas recently or do I need to stop at a gas station?
It was often a harried rush just to get to the car, let alone the doctor’s office. That’s why I felt it was so important to plan ahead the night or even days before.
In his book, What Dying People Want: Practical Wisdom for the End of Life, Dr. David Kuhl gives some thought-provoking suggestions for visiting the doctor’s office. What I’m presenting here is a mere snippet of this information:
Before the appointment, list your concerns in writing. Then prioritize them. Its always a good idea to put a notebook and pen in your bag for note-taking at the doctor’s office. At the beginning of your appointment explain to the doctor how many concerns you have and then inquire regarding the time constraints of the appointment. Deal with what you can in the time provided, keeping to your pre-assigned priorities.
Be specific about symptoms and issues (You should have notes to refer to regarding these).
Regarding tests: be sure you ask and understand what the tests are for, what they will involve. (Make sure the person in care has a chance to ask questions, to get answers, too!)
When given a diagnosis, ask questions until you are sure both you and the cognizant patient understand.
If given a new prescription, find out what the proposed effect is. How long will they take it? How will it affect them? How will it react with their other medications?
To sum up, its good to always clarify what the doctor is saying. Be sure you truly understand the processes you’re about to embark on. Take notes. And perhaps most important of all, make sure the patient is comfortable with his/her own level of understanding of what’s being said.
Have you ever felt betrayed by or angry at a health care professional?
Perhaps you thought you were not getting complete information about diagnosis and treatment plans. Or maybe you felt certain aspects of the treatment, diet or delivery of medication could be done in a more effective and less intrusive manner.
Many of us who are caring for the needs of our loved ones, who act as advocates in the doctor’s office, at the nursing station and in the face of home care workers can find ourselves suppressing feelings of anger and resentment.
Both the patient and the caregiver may be reluctant to express concerns. Some simply may not know to whom or how they should put their questions.
For those patients and caregivers these unexpressed concerns can cause anxiety and even conflict with those in the health care community whose very job is make life easier for the patient.
Dr. Kuhl, a palliative care doctor, suggest that sometimes doctors and nurses can be so familiar with certain diagnosis, treatment plans, and even the hospital environment that they fail to take into account the patient’s lack of understanding of processes and terminology.
Ask questions, be proactive in your quest for knowledge about your condition, the diagnosis, the treatment plan and what all of this means for you or your loved one.
Decision making should involve your input. Family and friends can assist you in this endeavour.
Why is it so important to understand what is happening and how? Because Dr. Kuhl’s research has shown him that suffering is diminished by both the patient’s ability to understand his situation and his sense of having some control over the treatment path.
This column is inspired by Dr. David Kuhl’s book, What Dying People Want: Practical Wisdom for the End of Life.
On this, the anniversary date of Chris’ passing, I remember. I play his favorite songs on the car stereo as drive to his grave site. I drive the old T-Bird he got for my son. If no one else is about, I’ll rev the engine as a salute on my way out. While I’m there, I tidy up a bit; trim the grass, water the flowers or add some new ones.
Of course I chat with him. He always said he wanted to be buried rather than cremated because he wanted somewhere people could come and visit him.
Some anniversaries I’ll make a coffee date with those who were special to him. Like the great gal from the Benjamin Moore paint store who would always put on a fresh pot of coffee for him.
He was a good man and my great love and these are my ways of remembering.
Everyone honours their loved ones in their own way.
When my brother died, my sister in law, Kamla, arranged a memorial scholarship for Jack. Anyone can still contribute if they like and it helps young people shape their future. A hockey and softball coach, Jack was always interested in helping young people develop their skills. Well thought of at work, Jack’s employer had a bench installed in the local high school grounds dedicated to him.
Also, my brother loved to camp with his family on this one particular site on Arrow Lake. Now every year Kamla hosts a big camp out, with games and remembrance balloons that carry felt pen messages into the sky on the anniversary of his death. Cousins, nieces, nephews, siblings, grandkids and friends from all over come for this annual event.
In some cases, budget restrictions dictate how we will remember our loved ones. It really doesn’t matter. Whether you have a mass said, or party hearty, it’s the thought, the memories and the heartfelt love that really count.
What Dying People Want is a doctor writing about his very human journey through the suffering of the terminally ill and the desired emotional and practical responses from health care professionals. Most importantly, Kuhl addresses situations and how to approach them for best results, always bearing in mind that what the patient most seeks is some sense of control over his life and the treatment of his illness.
I remember it was always a hassle getting out the door on the morning of Chris’ doctor’s appointments. He liked them to be early in the day, I think because he felt best able to cope then–his energy levels seemed slightly higher in the morning, though he soon flagged.
We lived a good thirty kilometres drive through rush hour traffic, and at the end, paid horrendous hospital parking lot fees. Then there were the interminable hallways, steps and elevators to negotiate within St. Paul’s. For Chris, these sessions were exhausting. Near the end, the toll on him was severe.
But he had been treated at St. Paul’s from the night of his very first heart attack, when we lived in the West End five minutes drive from the facility. And in the end, the young doctor who had treated him then became the head of St Paul’s Cardiology Department, and in the years between, he and Chris built up a good rapport.
So David Kuhl’s book, based on research done at St. Paul’s struck a chord with me.
Several aspects of the book appeal to me. Kuhl introduces each chapter with quotes from patients, followed by an anecdote, legend or myth that speaks to the theme of each chapter. He uses his own experiences and those of terminally ill people to illustrate their concerns.
I found it to be practical and profound. Any comments you may have on the book would be appreciated. Just email me at firstname.lastname@example.org
These next few blogs are based Dr. David Kuhl’s book, What Dying People Want., based on his research and experience as a palliative care physician serving at St. Paul’s Hospital in Vancouver, B.C.
During the days of tending your loved one, you are constantly engaged. Doctors, health agencies, pharmacists, family and friends are all involved in the work you must do.
But who do you talk to when you’re suddenly feeling overwhelmed or dismayed? Or when you need respite care?
Or perhaps, like me, those days are over. And like me, you may suddenly find those days that were filled with innumerable tasks suddenly stretch before you in an endless array of emptiness.
Everything is quiet and still and you begin to feel the pain. Where do you turn for help?
Thrift shops have always been a mecca for me when I’m down–looking over the items seems to help me focus on something other than my present state. One day when I was in the White Rock Hospice Thrift Shop, I mentioned to the clerk that I was trying to find a source of grief counselling.
At once she said that the Hospice Society provided such a service. She handed me a pamphlet with a list of all the services they provide. I was surprised to see that these included bereavement walks, as well as grief counselling individually or in groups.
The best part? It was all free!
For caregivers the hospice societies offer many services including counselling for both the family and the patient. They also act as a resource centre offering information about services they and others provide, including respite care, one on one support and palliative care.
So if you’re looking for any of these services just Google your community hospice society or head on out to your local hospice thrift shop.
Once I found the hospice services, I no longer felt alone in my grief. And I’ve found it easier to situate myself in my new reality.