End of Life Care

    On Tuesday, April 29, SPPC will be hosting another workshop in our on-going series on health care for the elderly and for patients with a terminal diagnosis, with Linda Cliff as our presenter.
     Linda has extensive experience in nursing, hospice and community health, and a true passion for her profession.  Her last workshop, in November, was titled,  
Let’s Talk About End of Life Care

  Here is a summary from her notes

                                           

    Hospice Care began to be formally organized in the late ‘70s in Canada. In those early days the care was described as “skilled and compassionate care primarily directed to dying and the bereaved to meet physical, emotional and spiritual needs”. By 2002 there were subtle changes to this definition “an approach that improves the quality of life of patients and families facing problems associated with life threatening illness and the prevention and relief of suffering.

     The emphasis has switched from the dying to the quality of living. Today we are using the term End of Life Care, as our population ages we are interested in the quality of living until we die.

     How can we accomplish this goal without ignoring the dying part of the equation? The answer lies in the application of the principals of Hospice/Palliative care. As our population ages, the demand for service will increase. Currently seniors represent about 14 percent of the Canadian population this group is expected to grow to 25 percent of the population by 2036. It is estimated that by 2025, two-thirds of Canadians who die will have two or more chronic illnesses and will have lived for months or years in a frail state of health. There is a way through this challenging situation and it involves an integrated approach to care that has been named the Palliative Approach. The care is patent centered, includes open communication between caregivers and patients and their families about the illness trajectory and advanced care planning, and psychosocial and spiritual support for both patients and family members. It focuses on providing care and enhancing quality of life throughout the illness using knowledge of pain and symptom management.

     This care requires patients and families to be involved with their care team, for them to be informed and seen as partners in health care. It requires that patients be given accurate information about what can and cannot be done for treatment of their disease. When we focus on this type of inclusive and informed care we are able to improve our quality of life even when we are dying. A caring approach such as this will help us all to find the dignity we long for as we face end of life challenges.
                                      ***

     The above is just a brief overview.  Linda provided much more information at the meeting and was available to take questions.  So, if you missed that one, here's your chance to mark your calendar for the next one, April 29, at 10:00 am in the Molloy Hall.  
     We will all face these end of life decisions one day, so it doesn't hurt to be prepared, and where better to face difficult matters than in the loving community of our congregation.

Grief and Loss part II

Tuesday morning a caring group of people gathered to listen to Linda Cliff,  discuss grief and loss from the perspective of a hospice nurse.
Some of the key points raised were:
 "Grief as a Life Journey."  
  Grief is a process and we never "get over it."  We will move on.  We will find a new normal
                                  for our lives.  But the  loss we've experienced
                                  is always there and may be  triggered at
                                  unexpected moments. 
                                  This is normal.  This is life. 

"Grief is Complex"
             While the Kubler-Ross model of denial, anger, bargaining,
             depression and acceptance is useful, it is not the only way
             grief is experienced.  All of these stages may occur in one
            day, some may be skipped altogether and they may be
            experienced out of order.  This is normal.  Grief is complex.

"Grief is a process of transforming a relationship , rather than detaching from it."
             As Christians we know that death is not the end. Life is
             eternal.  Love is eternal, but death makes the expression
             of that love different.  It takes time and patience to come
             to terms with that transformed relationship.

"Anticipatory Grief"        
             Sometimes there is a long period of grief that occurs before
             a death.  During that time, people will experience some or
            all of the usual aspects of grief that occur after death.
            Sometimes this makes the bereavement time easier. 
            Sometimes it doesn't.  Each person's grief is individual.

"Multiple Losses"
               Sometimes it feels as though one loss is piled on top of
               another.  The loss of a loved one may necessitate the loss
               of a beloved home.  Deteriorating health may result in loss
              of independence, loss of association.  Financial reverses
              may cause a dramatic shift in life-style.  Grief over these
              losses is natural and normal. 

"Guilt"
            As though bereavement and grief were not hard enough,
            often we add  a layer of guilt to ourselves.  I should have
            done better."  "I should have been more patient."  "I should
            have said 'I'm sorry'."  When these thoughts intrude, try to
            be kind to yourself.  Talk to a supportive friend.  Dwell on
            what you did well.
            You did make the important telephone calls.  You did spend
           days at the hospital or bedside.  You did carry out the final
           wishes.  

"Support"
            Grief hurts.  It is natural to shy away from a grieving person,
            but our presence is one of the greatest gifts we can offer
            our hurting friends.  Listen while they talk.  Invite them to
            tell stories of the departed.  Be willing to hear the same
            story over and over.  Call.  It takes a monumental effort for
            a grieving person to reach out, but they need to hear from
            you.  Make the call.  Go out for coffee.  Take a walk
            together.  Be there.  Another's grief may trigger your own.
            You may cry.  Call anyway.  Call again.

Thanks to Linda for sharing her experience and her knowledge with kindness and compassion.


Editor's Note:  Reference material is from "Medical Care of the Dying," 4th Edition edited by G. Michael Downing, MD and Wendy Wainwright, MEd.  Published by Victoria Hospice Society Learning Centre for Palliative Care
Victoria Hospice has a wealth of materials available which can be downloaded from their website. Go to Victoriahospice.org. 

Prepare!

    "Therefore keep watch, because you do not know the day or the hour.  Matt 25:13

   This verse refers to Christ's return, but foresight is a valuable quality at any time.  This past Sunday, SPPC conducted an information session on emergency preparedness.  We do live in an earthquake zone, after all. 
   Even if the big one doesn't hit in the next few years, there will undoubtedly be power outages this winter, so it is a good time to think of how we can care for ourselves for 36-48 hours.  Guests from the Sidney Fire Department brought examples of survival kits, some small,

And some large, all approved by both the Canadian and US Coast Guard.  If you're like me, you put off assembling a kit yourself, so it's great to have the opportunity to buy one already put together.   The food and water inside are guaranteed for five years so you won't have to replace it in a hurry!  Joe McCracken from our Session is taking orders for anyone who wants to purchase an emergency kit.  He suggested they make a perfect gift for that someone who has everything. 

      For more information, or to order a kit, call the office at (250) 656-2241

From Linda in Nepal

 I thought I would try and give you a run down on the day in the life of our time so far in Chitwin. Chitwin is a southern province of Nepal. It is a jungle region and very flat. As a  matter of fact we have not seen the mountains yet! The weather in Kathmandu was both foggy and smoggy so we did not see them and here the weather has been foggy in the morning and overcast most days. This is unusual for the region. We have even had rain which is not typical.  We also experienced a earthquake. I felt it.  In fact, I thought an animal had jumped on my bed!!!


Now a snapshot of our days......

 We get up around 0730 as we need to be either in class or at the hospice at 0900. Breakfast is a simple affair of instant coffee or tea, instant hot cereal and fruit. We do not have cooking ability and eat everything we prepare out of a teacup, now we have 2 cups so we can have our coffee and eat our cereal at the same time.


Showers are an adventure. There is no hot water.  There is a large tank on the roof 1000 litres and if it has been a warm day the day before and not too cold overnight you can get this not so cold water. There is an art to a daily shower in cold water. You do not stand under the nozzle, you do soap yourself all over then you rinse in parts. For hair you just take a deep breath and go for it. The air around you is warm so it is not as cold as it would be in Victoria. Also you are not in a stall, the shower nozzle is in the middle of the bathroom and you just turn it on.  There's a toilet on one side, sink on the other so there is room to stay away from the water and just rinse in sections. Believe it or not when done you feel just as clean as you did at home, just more invigorated.


We walk to class or the hospice unit, very pleasant but there are still a lot of motorbikes and bikes on the road so you have to watch where you're going. The hospital system here is one of lining up rather than appointments, so the roads and side walks are full of people going to the cancer hospital. The flow of people seems to start at about 0600 in the morning so there is a lot of activity.


We eat lunch and supper in the canteen attached to the hospital. The menu rarely varies so our diet consists of: chow mien, daal bhat(rice, vegetables, daal, a spicy pickle), pohokora. samosas, chicken some days and our favourite potato chop which is like a croquette. We ask for potato chop every day, and the canteen manager will say ready at 2 o'clock. We go back and he says ready at 6 o'clock, and when we go for supper he says tomorrow. This means everyday we are excited when we arrive at the canteen only to discover tomorrow will be the day! Every other night we eat western which means cup of soup, chips, crackers, chocolate bars, peanut butter in our little house. You can only take so much rice in a week.

Laundry is another of our weekly challenges. We have 3 choices: the bathroom sink, a bucket at the tap in the yard or wear your clothes dirty. Since the last is not an option we find that one of us is doing laundry everyday. The pastor's wife loaned us a clothes hanger so we look forward to warm days to dry the clothes outside. The locals are always walking by our little house looking at us.  I don't think they are used to westerners doing their laundry in the front yard. Of course when you do laundry you run out of water in your tank. The first time we made a panic call to one of the nurses and she came over and showed us how to fill up the tank, so we have developed a routine to ensure we have water when we turn on the tap. We boil all of our drinking water and have a wonderful hot water dispenser so never have to worry about that.

Electricity has been good. There are random outages daily but we have our flashlights handy. There was one during the teaching day so we went to a building that has a generator and carried on.


Our evenings have turned out to be a great part of our day. The three of us Marjorie(RN) and Ellen(Dr) sit around and prepare our lectures, read, do sudoku, knit, and visit. When we arrived none of us were well versed in the use of power point, flash drives, or writing presentations. So we sat at the computer and tried all the buttons and now we can all write a presentation, do clip art, change the background and we are so proud of ourselves. When I think of all the years I worked and could never find the time to learn these skills. I can't believe I had to go to Nepal to learn powerpoint.

Bed time comes early, as the days are busy. The nights can be noisy with howling dogs and jackals, and all of the things that go bump in the night, and there are a lot of them. But morning comes and we start again. I can say we are loving it!
 We are off to the animal reserve in this week where we will ride on the elephants, see the rhinos and bears,  and, hopefully, get a hot shower!





The adventure continues.  Watch this space for the next installment.