“To help a patient die peacefully is so rewarding”

Dr Geoff Wells joined St Catherine’s Hospice in Crawley on a placement during the pandemic. Here he shares his experience of working on the hospice wards while COVID-19 is ongoing.

I’m training to be a palliative care specialist, and am about 18 months away from starting my first consultant position.  The first wave of COVID-19 was a very unsettled time for many junior doctors as we didn’t know where we might be working from one week to the next. Joining St Catherine’s in October 2020 meant I regained some continuity and consistency. I didn’t have to worry that I may be sent off to a random ward at a moment’s notice. This also meant I could concentrate my efforts on my palliative care work. 

On the hospice wards we’ve been adapting to an ever-changing situation. The most challenging thing has been the fact that we’ve had to place restrictions on visiting times and numbers. It’s essential for the safety of our patients and staff that we limit footfall to reduce the risk of spreading COVID. That’s meant we’ve had to put in place strict rules that limit both the number of visitors and the length of time they’re able to visit.

At one point we weren’t really allowed to have many in at all. The restrictions have had a huge impact on the decisions our patients have had to make, as to whether they wish to be admitted knowing such restrictions are in place.

Caring during the pandemic 

As clinicians we always aim to keep the people that the patient has identified as important as up-to-date as possible. However with some families living far away and being unable to visit, it’s meant that there’s greater pressure on us to call individual family members to provide daily updates. Even with reduced patient numbers, that could potentially mean one of our hospice doctors or nurses making up to 24 phone calls in a day, which isn’t always possible.

Our priority is providing the bedside care our patients need, so we’ve worked closely with patients’ next of kin to ask them to disseminate information to wider family and friends when we don’t have capacity to ring all relatives.

It’s also been important to reflect on relatives’ expectations of speaking with a doctor. As doctors we often find that we’re not the most appropriate professionals to offer patients what they need. Instead it may be our nursing colleagues, therapists or chaplaincy team who are much better placed to address specific individual needs.

A supportive environment

I enjoy working alongside patients and relatives, and I feel privileged to be caring for individuals at one of the most vulnerable times in their life. That isn’t to say it isn’t challenging, and all too often I find myself working with team members as we negotiate uncertainty in a patient’s illness, trying our best to help them make the right decision.

Some people find it odd when they hear me say that being able to help a patient die peacefully with their wishes having been met is a rewarding part of the job. I’d ask those people to speak with the family and friends of those patients, and they will soon see that it makes all the difference knowing their loved one has died peacefully. Often dying with good symptom control can mean better quality time between a patient and their family, without the stress of poorly controlled symptoms denying a peaceful end of life.

Providing complex care

All too often hospices are perceived as being sad places, or places only where people come to die. This simply isn’t true. We don’t admit patients who don’t wish to be here, so we only admit those who have specifically requested to receive end of life care at the hospice.  Our care provides patients with security, safety and comfort, and addresses the wishes of those patients who are desperate not to die alone at home.

Palliative medicine is one of the few medical specialties where care is often not driven by guidelines or protocols. It is is so much more complex than simply sitting and holding a dying patient’s hand - difficult decisions have to be made and communicated to patients and families.

One of the challenges I wish to embrace when I become a consultant is to foster links with medical and nursing colleagues in other specialties, to support difficult decision-making and encourage open and honest communication.

• Our Frontline is a partnership between Shout, Samaritans, Mind, Hospice UK and The Royal Foundation of the Duke and Duchess of Cambridge. It offers round-the-clock one-to-one support, by call or text from trained volunteers, plus resources, tips and ideas to look after your mental health. Visit the Our Frontline site
• Hospice UK’s Just ‘B’ Counselling & Trauma helpline.  The service is a free confidential national helpline available 7 days a week from 8am to 8pm, providing bereavement, trauma and emotional support for all NHS, care sector staff and emergency service workers. Call the ‘Just B’ Counselling & Trauma helpline on 0300 030 4434.