Heard the tail-end of a report on the radio today, which said access to morphine for end of life pain relief is tightening world-wide. This, at a time when we also hear governments are concerned access to addictive drugs such as morphine is too easy. We need to get the balance right.
A World Health Organisation report of August 2017 says:
Each year, an estimated 40 million people are in need of palliative care, 78% of them people live in low- and middle-income countries.
Worldwide, only about 14% of people who need palliative care currently receive it.
Overly restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate pain relief and palliative care.
“Children can experience grief and loss from a very young age. Like adults, children have their own ways of grieving. It is important to recognise that your child has feelings of grief and to help them express those feelings.”
“Children are curious, so be prepared for regular and repeated questions. Be clear and honest with your responses.”
“Don’t pretend that you are not sad – express your feelings to your child. This can help your child feel able to express their own feelings.”
These ideas come from a great resource to help manage the grief of a child.
Troubled stories from recent deathbeds remind me of a sign at my daughters’ old school: “Beware falling pods!” The sign sat at the base of an enormous native fig tree and when those pods fell, they were like malevolent missiles. Dropping from a great height helped the pods to crack open (along with trampling by school shoes) to reveal their large seeds. Maybe families are like those trees. They grow large and strong and when an elderly parent is dying it’s a very common time for conflict and tension within families to erupt – whether over management of care, how the person’s wishes should be respected or the inheritance of important items from their life, like a ring or a chair. So it’s a time we need the “Beware falling pods!” sign. The pods hurt when they hit, but their forceful drop to shatter open, although unpleasant, is part of the life story of the tree.
“I began my grief journey eight years ago with the unexpected death of my only child and son, Carl – a beautiful young man, loved by many. His loss left me feeling bereft and fearful about what lay ahead…No day was ever the same. One thing became very clear to me, grief kept changing its form. It was kaleidoscopic in nature, unpredictably variable. During my reflections, metaphors came to me often. I wanted to share many of these – hard-won as they were.
“It could be used as a grief self-help book, as well as a resource for grief and loss counsellors to stimulate discussion and raise grief themes to assist struggling clients. “
Su-Rose’s book is published by Morning Star Publishing.
When I first started writing my book We’re All Going To Die there weren’t many public conversations on the subject of death, but since then it has really moved along. Sadly, however, it hasn’t moved fast enough.
I’d like to see death education brought more widely into medical schools, for it to become part of every discussion, such as ethics, and how to communicate with patients, pretty much the same way sex education opened up and was being covered when I was a medical student.
This has happened rather effectively in other countries, such as the USA, with the introduction of ‘medical humanities’ subjects to students – but unfortunately, it hasn’t really taken off in Australia.
If this discussion around death was improved, I think it would really change things. There would be a really good platform for not just doctors but all health professionals, such as nurses or physiotherapists, who day in and day out support the dying.
Currently, there’s no formal debriefing mechanism for doctors and health care specialists. Of course we talk to each other and tell black jokes in the tearoom, but it’s not the same thing. Without more formal support, health professionals carry the impact of their interactions with death in a way that inevitably leads to ‘zooming out’ and a risk of burn-out or compassion fatigue.
Just this week I had to tell a patient, a young man with two small children who was doing well in his career, that he was completely riddled with an inoperable, terminal cancer, that the next thing he should do was go home and get his affairs in order. That’s a really difficult thing to have to tell someone but there is no formal, easily accessible debriefing mechanism for the doctors who must have those sorts of conversations, within our current medical facilities.
I hope this changes in the near future, because if it does, then we in the medical profession will be stronger and better equipped to give a much better quality of support to those experiencing the realities of mortality, either as someone dying, their carers or those who are grieving.
A story about the developing work of death doulas can be found on Page 90 in the October issue of The Australian Women’s Weekly, available now.
The introduction: “There is a quiet, serene revolution going on in the way we farewell our loved ones. Caroline Baum meets the women, known as death doulas, who prepare the way for the final journey with empathy and love.”
And a quote from Victoria Spence, who is interviewed: “No matter how violent or upsetting the circumstances, my belief is always that being informed and involved is healing, whereas denial is not.”