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We live in a culture that places a tremendous value on multi-tasking. Books, articles online, in magazines, and in business sections of newspapers extol the virtue of being able to focus on multiple tasks at the same time. This goes well with the “cult of busyness” that seems to have overtaken the Western world. Dare to ask a colleague how they’re doing as they race past you down the hallway, and they’re likely to shake their head and respond, “I’m so busy.” Indeed, busyness seems to be synonymous with “important” in the modern lexicon.

For the most part, these values do not hold sway in a hospice. At the end of life, everything slows down, and staff, volunteers, and family members tend to mirror the pace of each resident’s dying process. As I’ve written on this blog before, this focus on being fully present is one of the aspects I find most beneficial at hospice. I cannot properly be of service to residents and their families if my mind is racing with a million details and tasks.

Nonetheless, sometimes busyness does seem to intrude even in the sacred space of the hospice. I’m not talking about the genuine emergencies which do sometimes occur. I’m referring to the tendency of people sometimes to assume that if you do not appear to be “busy,” you are not actually doing anything and are therefore ready to be interrupted.

A recent hospice shift provides graphic evidence of the perils of interruptions.

Though not all the beds were full that day, there was no shortage of tasks to occupy my time. A bed to be made up, dishes to rinse and put in the dishwasher, lunches to make, coffee to brew. You get the idea.

About three quarters of the way through my shift, a staff member popped into the volunteer room where I was writing notes in the volunteer communication book. “Room 4 is ready for you to take her order.”

I quickly made my way to Room 4, where I found a woman wrapped in a quilt, sitting at ease in a large Lazy-boy chair.

“I hear you’d like some food!” I began, perching on the edge of her bed.

Immediately the bed alarm began screeching, alerted to movement by my weight.

“Oops,” I said, jumping up and pressed the reset button on the alarm. “What would you like?”

“What do you have?”

“Well, it looks like you had chicken shepherd’s pie the other day. Would you like that again?”

“No, I had that yesterday. What else do you have?”

“I could make you an egg salad sandwich.”

“With dressing?”

“Of course! White bread?”

“Yes, just one slice.”

“Coming right up,” I said, happy to have arrived at an item that appealed to her.

En route to the kitchen, a staff member called out, “The family in room 2 needs a tour.”

“Sure,” I said. “Right after I finish this.”

The kitchen was a busy place when I entered. A family member was heating up some stew for his lunch. “Do you have something I can store the rest of this in?”

“Why don’t you heat it up in this bowl and save the rest in the original container?” I suggested. “And I just made some fresh coffee if you’re interested.” I reached into the drawer to grab him a cup.

When another family member joined us, I offered her a cup of tea, pointing out the range of choices Tim Horton’s has generously donated to us.

“OK,” I counseled myself, “time to make Mary’s lunch.”

I checked the freezer for a small container of shepherd’s pie, removed the lid and popped it in the microwave. I had a nagging feeling there was something else she wanted, but carrots were the only thing that popped into my mind and I knew she’d rejected that.

When the microwave beeped, I took out the bubbling container and transferred it to a bowl. I added the cup of very weak tea she’d ordered (“Just put the bag in and take it right out again!”) and placed it on the tray. I felt proud of my ability to focus on the task at hand in the midst of competing demands!

When I presented the tray to Mary, she looked at me with horror.

“I asked for an egg salad sandwich,” she said.

“Oh my God, I can’t believe I did that. I am so sorry.” I kept repeating that over and over again. “I’ve never done that in my life. I am so dumb.”

“Don’t worry about it,” she commanded, hoping for an end to my litany of self-judgment.  “Just make me an egg salad sandwich.”

To make sure I wouldn’t forget her order again, I wrote “egg s. 1 w. bread” on my palm.

When I returned with her order a few minutes later, she gave me a look of approval. I waited until she’d taken her first bite and pronounced it “just what I wanted,” before heading off to my next assignment.

I’d like to think I’ll never make that mistake again but I know there’s a good chance I will (though not the very same one, I hope!).  I know that we are all subject to information overload. I hope I will remember to  ask someone if they are busy before I interrupt them. And I hope that my colleagues at hospice will do the same. That way perhaps we can all remain in the moment.

 

 

 

 

 

 

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I’m excited to see so many visitors to the hospice volunteering blog this week. I’m grateful to Hospice Care Ottawa for including the blog in their monthly newsletter for volunteers and staff. I hope that many readers will choose to follow the blog – that’s the easiest way to ensure that you keep receiving it on a regular basis. I don’t post a great deal – at most once a week, but often less, as life carries me away to other pursuits. There’s a button on the page that says “follow‘ – just click on that, give your email address, and you’ll get a message each time I post.

I have another reason to thank Hospice Care Ottawa – they graciously hosted the latest Death Cafe at the May Court Hospice on Monday. We had a great turnout – and from the buzz in the room I could tell that people were engaged in lively conversation. I know I had a great time with the three other people at my table!

I’ll keep you posted on other upcoming activities – here in Ottawa and elsewhere. In the meantime, feel free to share this blog, and to read the archived posts on this site. Thank  you!

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Hallowe’en is almost upon us and (coincidentally) Ottawa will be host to two death cafés!

The first one will take place at the May Court Hospice on Monday October 30. Registration is required so please contact: deathcafeottawa@gmail.com

See the death cafe website for more information.

https://www.facebook.com/deathcafeottawa/?rc=p

The second event will take place on Wednesday November 1st at the Art House Cafe:

COFFEE, CAKE AND MORTALITY
Death Café. A sequel.

Death Café? Ask the uninitiated what images those words evoke, and they’ll say morbid talk, the wringing of hands, and tears shed over coffee and cake. But they couldn’t be more wrong.
In early November a small group of people, led by Marit Quist-Corbett, will meet at The Art House Café on Somerset Street. Yes, there’ll be coffee and cake, but also laughter among friends and strangers as they discuss those often-taboo subjects of death, dying and mortality in a positive and open discussion.

WHERE: The Art House Café, 555 Somerset Street (kitty corner from Dundonald Park).
WHEN: Wednesday, November 1st, 1pm to 3pm
For more information, please call or email one of the following:
Marit Quist-Corbett,  mquistycorbett@gmail.com

 

I’m hoping to attend both events so perhaps I’ll see you there! I won’t be wearing my Hallowe’en costume (Spider-Granny) – too hard to eat cake with it on!

 

 

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I’ve been doing lots of reading about death and dying over the past months (so what else is new? you are saying to yourself, I’m sure) and I enjoy sharing some of the great articles I come across. Much of the writing comes from the US – and the differences between our two systems of health care are so great that much of what is written about hospice and end of life care is not directly relevant to Canadians. When I came across this great article from Australia, I immediately wanted to share it. Interesting to note that Australia came 2nd in the world on the rankings of end of life care. I think Canada came 9th. We have much to learn!

When life is coming to a close: three common myths about dying

Dying at home isn’t necessarily a good death

On average 435 Australians die each day. Most will know they are at the end of their lives. Hopefully they had time to contemplate and achieve the “good death” we all seek. It’s possible to get a good death in Australia thanks to our excellent healthcare system – in 2015, our death-care was ranked second in the world.

We have an excellent but chaotic system. Knowing where to find help, what questions to ask, and deciding what you want to happen at the end of your life is important. But there are some myths about dying that perhaps unexpectedly harm the dying person and deserve scrutiny.


Read more – A real death: what can you expect during a loved one’s final hours?


Myth 1: positive thinking can delay death

The first myth is that positive thinking cures or delays death. It doesn’t. The cultivation of specific emotions does not change the fact that death is a biological process, brought about by an accident, or disease processes that have reached a point of no return.

Fighting the good fight, remaining positive by not talking about end of life, or avoiding palliative care, have not been shown to extend life. Instead, positive thinking may silence those who wish to talk about their death in a realistic way, to express negative emotions, realise their time is limited and plan effectively for a good death or access palliative care early, which has actually been shown to extend life.

For those living closer to the prospect of death, being forced to manage their emotions is not just difficult but also unnecessary, and counterproductive to getting the help we know is important at the end of life.

Myth 2: dying at home means a good death

The second myth is dying at home always means a good death. While Australians prefer to die at home, most die in hospital. Managing a death at home requires substantial resources and coordination. Usually at least one resident carer is needed. This presents a problem. Currently 24% of Australians live alone and that’s predicted to grow to 27% by 2031. We also know many Australian families are geographically dispersed and cannot relocate to provide the intensive assistance required.

The role of the carer may be rewarding but it’s often hard work. We know timing of death is unpredictable, depending on the disease processes. Nurses, doctors and allied health professionals visit, problem solve and teach the carer to perform end-of-life care. They don’t move in, unless they’re hired in a private capacity; a possible but pricey alternative. Finally, specialist equipment is required. While this is usually possible, problems can arise if equipment is hired out for a specific time and the patient doesn’t die within that allotted time.


Read more: To die at home or in hospital? Aussies want one but we fund the other


It’s not a failure to die in a hospital, and may be the best option for many Australians. While it would appear that large public or private hospitals may not be the best places to die, in many areas they provide excellent palliative care services. Appropriate end-of-life planning needs to take this into account.

Myth 3: pushing on with futile treatment can’t hurt

A window of opportunity exists to have a good death. Pushing on with treatment that has no benefit or is “futile” can be distressing for the patient, family and the doctors. Doctors are not obliged to offer futile treatment, but unfortunately patients or family may demand them because they don’t understand the impact.

There are cases where people have been resuscitated against better medical judgement because family members have become angry and insisted. The outcome is usually poor, with admission to the intensive care unit, and life support withdrawn at a later date. In these cases, we have merely intervened in the dying process, making it longer and more unpleasant than it needs to be. The window for a good death has passed. We are prolonging, not curing death and it can be unkind – not just for those sitting at the bedside.


Read more: Doctors still provide too many dying patients with needless treatment


The story of a good death is perhaps not as interesting as a terrible one. Yet there are many “good death” stories in Australia. There are likely to be many more if some of the myths that surround dying are better understood.

 

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There’s been lots going on in my life in the past couple of months – and I haven’t been writing as much as I’d like. But I have been reading, listening and talking about end of life care, death and dying, and I’ve been sharing some of the amazing resources I’ve discovered. As I write this, I’m listening to a fabulous interview with Dr. Susan MacDonald, the medical director of palliative care for Eastern Health. She’s an amazing, passionate advocate for palliative care, and she explains things with a clarity and understanding that’s rare.

Here’s the link:

http://www.cbc.ca/news/canada/newfoundland-labrador/tedwalks-podcast-susan-macdonald-1.4279306

She’s funny, bright, wise, and very forthright. I’d love to meet her!

The interview is particularly timely for me because this past week I found myself engaged in a discussion with the RN and PSW on my shift. It was a quiet shift, and we had the time to talk in a way we don’t often have. Issues ranging from the differences between palliative care and hospice (if there are any!), the reasons why people with heart failure tend not to be referred for palliative care, and and why people often think that opting for palliative care means “giving up.” It was a great conversation, and it was wonderful for me to be able to share some of what I’ve learned in my research and writing.

The discussion left me wishing that we had more opportunities to talk as a team, to share our different perspectives and to bring our unique insights to the team.

So please listen to this wonderful interview – and feel free to share your comments.

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My Interview Is Up Now!

https://www.itsabouthowyoulive.com/katherine-arnup/

My interview for the summit is available now. Just click the link above. (Sorry to those who received an earlier message without the link!)

 

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I thought readers might be interested in checking out a FREE telesummit I’m participating in.

I am one of the experts participating in a free Telesummit called It’s About How You LIVE.

The Telesummit features 21 experts who will help you take the fear out of conversations about advance care planning, serious illness, hospice care and grief. Are you a medical professional? Caregiver? Just want to learn more about these important topics? Then this is for YOU!

Register Here!
https://www.itsabouthowyoulive.com/katherinearnup

My interview will air on September 18th. Register now so you can see all the details.

It’s About How You LIVE! FREE Telesummit for medical professionals, caregivers and anyone interested in learning more about advance care planning, serious illness, hospice care and grief. Do not miss this free opportunity to learn from the best of the best! Register Here!
https://www.itsabouthowyoulive.com/katherinearnup

I hope you will join me on September 18th! And check out the other experts while you’re there! All the interviews will be archived, so you can listen to them at any time.

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