Victoria Bradley & Matthew Carey, Consultants
7.45am We catch up over coffee in our office and review the events of the night. Matt has been on-call, which means that he receives calls asking for his specialist help and support throughout the night. These calls might come from patients and their families who are looked after by the Sobell House team. Or, they might come from other health professionals such as out of hours GPs, hospital staff or ambulance staff who are struggling to care for patients in their homes and hospital beds all over the county. He’s had several calls overnight from a local nursing home asking for advice on how to manage a lady’s pain as she is dying and can no longer take her tablets and he’s helped them to manage the pain using injections. The first order of business today is to speak to Lisa in our community team who knows this nursing home well and see if she can go out to see the lady first thing to ensure that she’s comfortable and that we can maintain that.
9am Although as consultants our responsibilities span all parts of our service and we might also be involved in supporting patients in the hospital or at home, our main focus is on the inpatient hospice ward. Together with Matron Karolyn and Ward Manager Rochelle we help to lead the ward team and look after the 18 beds which are used for patients with complex symptom control or end of life care needs. At 9am we join the admissions meeting where all patients who have been placed on the waiting list to come into the hospice are discussed and prioritised. Our beds are such a precious resource and so we agonise over the decision making together and try our very best to not keep people waiting too long.
9.15am Our varied and vibrant multi-disciplinary team is the beating heart of the hospice and handover is when we all gather together to hear the nurse in charge give us details of the events of the night and planned activities for the day. The meeting has to be efficient and convey lots of information, but it also full of moments of lightness and sadness as we talk about patients who we have grown to know and care for. Deputy Sister Christina always brings a smile to our faces and today there is laughter in anticipation of a particularly boisterous pet Labrador visiting.
9.30am Victoria, together with two Junior Doctors Charlotte and Simeon and the Co-ordinating Nurse Damian, undertake a ward round to review patients. The hospice has a number of doctors in training, both those training to be General Practitioners and those training to be Palliative Medicine Specialists, and our role in teaching and supporting these young doctors is vital – both for their work here in the hospice and to ensure a solid future of excellent care for people with life-limiting illness in Oxfordshire. Often medical students can get as little as 20 hours tuition on Palliative Care in 5-6 years of medical school and so this educational role is so important.
No day for us is ever “typical” and neither is any patient – and for us the importance of the individual as a person is paramount. Victoria sees two ladies in the bay who are in adjacent beds who couldn’t be more different in age and background, but they have formed such a deep bond it’s wonderful to see the support patients and families offer each other. By the end of the ward round there have been pharmacological equations undertaken to manage nausea, three ice lollies delivered for dry mouths, referrals made for benefits support and advice, plans for a nerve block to manage complex pain, and a set of toenails trimmed!
12.30pm Led by Ward Manager Rochelle, the ward weekly meeting brings the whole team together to discuss each patient in turn to ensure that we offer a truly holistic assessment and support for our patients and offers all staff an open environment to contribute to decision making. Matt shares a challenge with the team about how we might help a family reconcile as their mother is dying and there are great suggestions from Rachel, one of our Chaplains, and Tom, our Music Therapist.
We also take time at this meeting to talk about all the patients who have died on the ward in the last week. It allows us as staff a moment to remember people and respectfully mark their passing, and it also gives us an opportunity to ensure that we focus on the next phase of the hospice’s work in offering bereavement support to families.
2pm Matt leads a family meeting on the ward together with Chris, one of our Social Workers, to talk about the future with one family. The man they love is rapidly changing due to an aggressive neurological disorder. The meeting is a chance for Matt to give information about what we know is likely to happen in the coming days and weeks, to answer any questions, and together with Chris to explore the family’s needs and how we can help support them.
3pm Victoria is back in her office and one of the key focuses of her work when she is away from patients is how we can ensure Sobell reaches everyone that might need us – including groups such as prisoners and rough sleepers who often have real needs that don’t get met. This often involves collaborative working with other healthcare groups and charities to try novel approaches for different populations.
4pm Matt is phoned by Amelia, one of the Senior Specialist Palliative Care Nurses in the Hospital team, who is currently seeing a patient in the Churchill Hospital with a complicated blood cancer who has suddenly become very unwell. They talk through the details of the case and Matt is able to join Amelia on the Haematology Ward, where it is clear that this gentleman is dying. They use medication to ensure he’s comfortable; call the Roman Catholic chaplain urgently to offer spiritual solace and ritual and offer support and reassurance to his family and the ward team. The family are finding it hard that he is in a clinical environment so Matt and Amelia work to remove as much medical equipment from the room and bring in a stereo to try to make it more homely.
6pm It’s Victoria’s turn to be on-call tonight and so we catch up together at the end of the day to share our thoughts and plans for the hours ahead. Our work is complex and varied but always a huge privilege.