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Anna Sutherland, Palliative Medicine Registrar

This diary was written in February 2020

08:45 I arrive at work in time to join a national research conference call. Palliative care services are working together around the UK to ensure we learn more about the best treatments to offer our patients so that we can manage their symptoms well. We meet by phone regularly to keep each other up to date.

09:15 Handover begins. I’m at the John Radcliffe Hospital today to review patients with complex palliative care needs, but I’ve just had a week off with my three children, so the team give me a really good run down of everyone we are involved in supporting and we agree plans for each patient individually. Most patients will be seen by our team of nurse specialists and our specialist occupational therapist, who are knowledgeable and skilled. My role as Senior Palliative Medicine Trainee Doctor is to see the most complex patients – which may be because of symptoms, communication issues, or other concerns.

10:00 I begin my ward reviews. One of the patients I see, Gemma*, is having seizures. Christina, the specialist nurse working with me, gets the injection to stop the seizures and within 5 minutes her face relaxes, the twitching stops and her husband is very relieved. Gemma is not well enough to swallow tablets but needs anti-seizure medication. We use a small syringe driver pump to gently and steadily give the medicine over 24 hours as a continuous injection so that we can maintain this calm while the acute medical team start an alternative anti-seizure medication. We work closely together, using anti-seizure medications which can take up to three days to be effective, while the syringe driver medications work in the background.

11:00 We are asked by the occupational therapist on the emergency admission unit to see Gwen*. Gwen is due to go home this afternoon but when the occupational therapist assessed her walking she noticed Gwen was struggling because of her abdominal pain. Gwen’s cancer is affecting her liver and when she breathes in she gets a pain at the top of her abdomen. We suggest a plan for stronger painkillers and steroids. The next day we hear her pain was so much better she was able to go home. We will refer her to have ongoing support from our community team to make sure her pain remains well controlled.

13:00 We stop for lunch as a team. We always like to eat together if we can. I forgot lunch today in the mad dash out the door in the courtesy car, my head full of things I need to remember, including booking extra childcare to allow me to pick up my car from the garage tomorrow on my way to work. I pop to the canteen and find trout and salad for lunch! A real treat and a lovely change from the usual sandwich!

13:30 We run through our list of patients again, checking who we have seen and who is yet to be reviewed. We check our plans for patients and I answer a few advice questions.

14:00 I catch up with my consultant by phone. We discuss plans for our teaching program for our new junior doctors. We discuss a trial we are currently running – we are a national centre studying a new drug to counter the insipient exhaustion cancer brings with it.

14:30 I review more patients in the afternoon. I meet Ruth*, who is afraid of what the future may hold for her. I explain that between active anti-cancer treatment and death there can be real quality of life and meaning. Realising that she can still enjoy good times with well-controlled symptoms means the world to her. I explain that this is what we do in palliative care.

15:30 I see a patient who has just been referred to us, John*, with our specialist nurse Amelia. We make a plan together to manage his vomiting symptoms. Other medications he has tried so far haven’t worked and he is keen not to have injections of anti-sickness. Instead we use a tablet John will only need to take once a day and that melts on the tongue.

17:00 I go back to the office, checking in with the team one last time. We have seen everyone, including the last two patients of the day referred in the final hour. Our nurse specialist team is amazing. I couldn’t do this work without them.

17:30 Email time! And a few other bits and bobs to work on before I head home. My phone pings with a message from the garage. I can pick up my car from the garage tomorrow, it’s in roadworthy condition again!

*Names have been changed for anonymity.