Newsletter No. 440

No. 440, 19.6.2014 3 For patients with diseases at an advanced stage, what they need is no longer a cure, but relief from suffering. Instead of resorting to life-sustaining instruments, such as CPR, nasogastric intubation and oxygen machines, it focuses on providing relief from distressing symptoms, such as pain, nausea and shortness of breath, to make sure that people die with dignity and grace. Preparing for the Final Journey To make sure patients get the medical care they would want, and meanwhile take some of the burden off their families, palliative care encourages advance care planning. It is the process of specifying future health care treatment when patients are still capable of deciding for themselves, and health care providers play an important role in assisting them to make an advance care plan. ‘Many people mistakenly believe it is inappropriate to bring up such sensitive subjects with patients. That’s why we teach students the correct way to communicate and broach the subject. At first the students found it hard to start the conversation, but it turns out that patients are ready to talk as long as the question is asked,’ said Prof. Diana Lee ( left ), director of the Nethersole School of Nursing. Finding the Meaning of Life In the face of death, people tend to ponder or even doubt the meaning of life. The Nethersole School of Nursing teaches the concept of ‘life review’ so that students can use it to assist patients to find their life meaning. ‘They should have a positive evaluation of themselves at the end of their lives. Many of the patients would say they had accomplished nothing, but they neglect the fact that bringing up their children already counts as a major accomplishment,’ said Professor Lee. The school’s gerontology programme has an assignment in its curriculum that requires students to visit an older adult with chronic illness and make him or her a ‘life story book’, that will enable the seniors to have a bird’s-eye view of the different stages of their lives, instead of dwelling too much on the negative experiences. A Team Approach to Care Palliative care employs a team approach to minimize pain and suffering. The core team includes doctor, nurse, chaplain, social worker, dietitian, psychologist and volunteer. ‘Accordingly, our gerontology programme is a multidisciplinary collaboration. We have in-house doctors, nurses, psychologists, sociologists and social workers. We will invite occupational and physical therapists to give lectures, and chaplains to speak on spiritual topics,’ said Professor Lee. Professor Chan said palliative care started in Hong Kong two decades ago. Around 15 hospitals are now providing palliative care services. Professor Lee held that palliative care services should not be the exclusive responsibility of palliative care units, but a necessary knowledge and skill that all health care providers should have. ‘It is so far a specialty. But the specialty needs de-specializing, since dignity and quality of life are something all patients deserve,’ said Professor Lee. 「生命回顧」功課怎樣做 The ‘Life Review’ Assignment 老年學理學學士課程一年級生楊嫦（左）、梁明善 Karen Yeung ( left ) and Jade Leung, Year 1, Bachelor of Science Programme in Gerontology 「我們的訪問對象是位八十多歲的伯伯， 共約見了四次才完成『生命紀錄冊』。 一開始準備不足，伯伯思維散亂，想到甚 麼就說甚麼，一勾起小時候經歷戰禍、 家人離世、自己孤苦無依，就哭得不能 自已。過了兩天，他還是哭得很厲害。我 們開始焦急：再這樣下去，就永遠找不回 他的人生！於是馬上重整策略，在第三天 做了個表格，按每個十年的節奏引導他回 憶，第一個十年做了甚麼，第二個十年又有 哪些成就，伯伯從中發現自己原來也有不少 開心回憶。 「聽完他的人生故事，我們在第四天為他設 計了一個手工環節，教他用五色彩珠製作一 串珠鏈，代表他整個生命歷程：綠色是他幼嫩的童年，黑色象徵他痛苦的經歷， 也是他花最多時間沉溺的黑暗回憶，紅色代表黑暗後的光明，白色是他後來的順 境，黃色是他現在的晚晴階段。藉此告訴他，他的人生不是一片黑暗，還有其他四種顏色。」 ‘Our subject is an old man in his eighties. It took us four visits to compile his ‘life story book’. At first we were inadequately prepared. He talked about whatever came to mind. When he was reminded of his childhood years when the war took away his family and he was left alone, he simply could not stop crying. It went on like this for two days, and we started to feel anxious: we would never be able to put together his life story! On the third day, we came up with a coping strategy—we drew him a table, with 10 years as a column, and asked him what he had done for every decade of his life. In this process he was reminded of his happy times. ‘On the fourth day, based on his full account of life stories, we taught him how to string beads of five different colours. It symbolizes the five different stages of his life: green his childhood, black his painful days, red the dawn after darkness, white his better days, and yellow his current retired years. We wanted to get it across that his life had not been spent in complete darkness, that there were other colours as well.’ 地揮別生命 End of Life