The biggest lesson that caring for the dying can teach you — reflections of a Palliative Care Doctor 

A few weeks ago I finished my Clinical Diploma in Palliative Medicine from the Royal Australian College of Physicians.

Without a doubt, it has the best and most challenging year of my clinical career.

It had such a profound effect on my life that I’ve decided to go all in and live the rest of my clinical life serving people in their last days.

I am not sure how this will translate into our lives here in Albany, but I go by faith, “being sure of what I hope for and certain of what I cannot see”.

But one thing is certain, especially with the recent recommendation to support a bill for Voluntary Assisted Dying in Western Australia, good quality, accessible and compassionate Palliative Care is needed more than ever before.

As I reflect on my greatest learnings from my year immersed in the practice of Palliative Care medicine, I’ve sat by the bedside of many patients across a variety of settings — in the Hospice, in the acute Hospital environment and my most treasured memories were being invited into a patient’s bedroom and being asked to manage their care.

There are over a hundred patients whom I have had contact with, fifty of which I logged in detail for my Diploma and have drawn significant learning from.

Most of these patients died expectedly.

A few very suddenly.

And there were a number who I grew very close to and helped significantly and was deeply affected when they died.

Many gained a great quality of life in their last days, which were longer than they expected, something that they and their family cherished.

This may seem surprising, given my work as a Palliative Care doctor, but as I am learning that in medicine, death does not always follow a predictable trajectory.

Twelve months into my new direction as a Palliative Care GP, I am uncovering that many aspects of palliative care work is challenging and requires wisdom and a deep well of compassion from a well-maintained self-care plan.

But there is one aspect that working with in palliative care has brought both peace to me and troubled me simultaneously.

It isn’t a concern about death, dying or the processes involved because I know this:

I will be given expert palliative care, comfort and symptom management, spiritual and social support which is in line with my expressed end of life wishes.

Although I am 38 years old and in excellent health, I have expressed my end of life wishes to my wife:

If I am faced with a terminal disease and I cannot speak for myself, please keep me comfortable, do nothing futile, nothing inappropriate and you are free to marry again!

Her response was “Okay…. but you’re not dying now are you?”

Funny lady.

I am not afraid of death because I know because I know that I will be looked after well and I have made peace with the afterlife as a believer in Christ.

Interestingly as Dr. Will Cairns OAM recently said as he addressed us at our Hospice a few weeks ago

“To work in Palliative Care, you must make your peace and develop your own understanding of death.

Be it religious, spiritual or academic, you must be comfortable with your own mortality and that of others, otherwise your discomfort will be unsettling to your patients and their families”.

But in talking to numerous patients and their families and being drawn into their lives, sharing in their secrets, their greatest triumphs and deepest regrets, I’ve learnt an important lesson about our days on earth.

The biggest lesson in Palliative Care

In working closely with the dying and conversing with patients in their last days, the biggest lesson I’ve learnt is this:

Don’t live with regret, when have the opportunity available to live your life fully.

The finality of death brings home that if you have an able body, a willing mind and a desire to live a full life, then the answer to most of the green lights in your life is simple.

Just do it.

Opportunity abounds in my life. 

I am young, healthy and educated and I live in a western democracy with free health care, clean water and a robust social security system.

If I choose to live, unconcerned about the opportunity that is overflowing in my life to make a difference in the lives of those close to me and in my chosen craft, then I am wasting my life.

Don’t waste your life.

A wasted life in the midst of opportunity overflow is a great tragedy.

Lost love.

Lost investment.

Loss of legacy.

Loss of friendship.

Loss of connection and life change.

Don’t let your last day be filled with regret

The existential crisis that regret causes in a person’s last days is overwhelming.

It can cause reciprocal suffering, that is suffering for both the patient, their family and their professional caregivers.

Regret can be seen in:

Unforgiveness.

Unrealised dreams and potential.

Unfinished business in broken relationships. 

The greatest of all being not able to truly express your love to those closest to you.

Regret is soul-destroying, often unable to be remedied and contributes to a dying patient’s “total pain” and suffering.

Make your days count

The one thing that the often non-glamourous world of aged and palliative care medicine is teaching me is that our days are numbered on this earth and that we need to make them count!

To live your life fully, you need to be clear about a few things, here are a few suggestions:

• Be clear about who you are: Write down your personal philosophy and let this guide you.
• Make a decision about the values that you will ascribe to and never compromise in how you live your life.
• Remember that being controlled by the opinions and thoughts of others is the clearest way to stay trapped and imprisoned in your life.
• Find your craft and spend your life becoming a master, teaching others and adding value to the world around you.
• Talk to your family about end of life wishes — what would you want them to do, if you couldn’t speak for yourself, how can they honour you?

I truly hope these words helped to guide you and if you would like to hear more from me, please subscribe to the www.thehealthygp.com .

Until next time.

Live intentionally.

Love relentlessly.

Enjoy your health.

Dr. Jonathan Ramachenderan
@thehealthyGP