Intensity in The C Word

I haven’t updated in forever - maybe one day I’ll be able to write without staring with that!

Maybe I should start with a trigger warning - this entry is about my work in palliative care.

Work has been next level intense. A while back we split the ward so it’s now two thirds haematology and one third dedicated palliative care. We’ve always provided palliative care, for our haem patients and also many other oncology/gen med patients as we are all side rooms so families are afforded privacy. Plus we do it incredibly well. We’re very experienced.

Some staff aren’t fond of this change, personally I’ve always wanted to make a move into palliative care at some point, it’s something I enjoy, and have always found incredibly valuable and rewarding. Having the dedicated beds means we now have palliative care consultants on the ward, alongside the usual and longstanding visits from the specialist palliative care nurses. I’m currently undertaking a palliative care degree module too - just the 4000 word assignment to write!

These last few weeks, 4 of our 8 beds have been occupied by young women with young families, all of whom have come into hospital feeling generally unwell, and have then received devastating diagnoses of advanced, terminal cancers, that they were entirely unaware of and not expecting. Absolutely devastating to all of them, and the implication for their young families has been horrific.

I work night shifts currently, it fits in with V, I can sleep while she’s in pre school. The conversations I’ve had with these brave women over the last few weeks have been nothing short of both heartbreaking and inspirational.

On a personal level, being able to provide that safe space for these women, for them to feel comfortable to open up to me about their innermost, middle of the night thoughts, is massively rewarding. Truly a privilege. So much of my work is, but these have been some of the most humbling moments of my career I think.

It’s not easy, being a mother to a 4 year old myself, having lost my own mum only 15 months ago and knowing how difficult that has been as an adult, there have been some incredibly intense and emotional conversations that have had me crying alongside my patients, quietly in the dark. What do you say to someone when they’re asking if their 5 year old will remember them? When they’re telling you that they didn’t just sign up to be a mum for 8 years, that they’re worried their husband isn’t coping and they don’t like seeing him impatient with the children.

How do you console a woman who is on her knees because the anxiety is so overwhelming, because it’s so unfair that they will have to leave their two children behind, that they’re worried how their husband will cope in supporting them because he was already under services for his own mental health before your diagnosis.

When I talk to C about it, he tells me I should be in palliative care now. That I can do more good in palliative care, having these conversations with people, allowing them to disclose their innermost worries and fears. I’m not sure I’m finished with haem and the hours don’t currently work for palliative care. Maybe when C is up here full time (good god but someone needs to buy his house and soon) then things will be easier, two adults in the house to do drop offs and pick ups. It’s a lot to think about, and I’m going to be working for another 30 years in all likelihood. C and I have plans to try for a baby towards the end of this year, swapping careers to something with different hours, more daytime hours, and less of them each shift so more days per week, isn’t what I want if we have another kid. Working just 3 nights a week allows me to spend so much time at home, with V, not missing out on anything, and I would definitely want that time if I had another baby.

**Fast forward 4 weeks from when I first started writing this - 3 of my ladies are doing OK, they’re off the ward, for more chemo, to home, to the hospice.

One of my ladies, B, passed away last week at just 36 years of age. Shortly before the end of my shift. I’ll be honest, I thought she would hang on until after I had gone home, but as her husband said - she waited for her favourite nurse to be here. B and I had really connected, she qualified as a nurse just one year ahead of me, her job was also in cancer care, she had two young children, and we just really hit it off. We had many a middle of the night chat, she would ask for painkillers and I would sit while they took effect, hold her hand, and chat, We had so many intense conversations, so much soul searching. How could this happen to her, when she had led a good life? She walked into hospital with rib pain and never left again. Would her kids remember her, the youngest is just 5. How would her husband cope. Her mum, brothers and sisters. Family dynamics, her dad had never been very involved and wanted to be now, she didn’t want him there when she died, she didn’t want her mum to be uncomfortable. It’s really incredibly special to connect with a patient and have them trust you, be able to turn to you, to truly be able to support them wholly.

I’ve thought about B and her family a lot. I came straight home from work that morning and V was super sick (temps over 40 degrees, screaming with ear pain, not sleeping, not eating. I haven’t had much time to process really, not as much as i’d have liked. I think we did a good job, her death was peaceful and dignified, with just her mum and husband which is what she wanted. She was incredibly settled and peaceful, with no symptoms at all in her last 24 hours. Her family were able to sleep at her side during the night, just quietly there, quietly loving her.

It’s what anyone would want, no pain, comfortable, surrounded by love.