Jenny: How is a hospice different from a hospital? Dr Ros Taylor: Well, there are quite a few differences. We try to focus not just on the patient and the physical symptoms but on the patient's whole world. By that I mean we involve family and friends and try to explore all the concerns, psychological as well as physical. We also have more nurses per patient than in hospital, so the care is very personal with lots of time for talking and listening - often difficult on a busy hospital ward. Jamie: Does everyone die once they come into the hospice? Dr Ros Taylor: Definitely not. In the early days of hospice care in the 1960s and 1970s, hospices focused just on terminal care in the last few days of people's lives. Nowadays, lots of our patients come in for a week or ten days to get a symptom such as pain or sickness sorted out, or even just for a week of pampering, and then they go home again. It's definitely not a one-way ticket! This is palliative, not terminal care. Katie Brown: Do you just look after cancer patients in the hospice? Dr Ros Taylor: Historically, the hospice movement developed to provide care for patients dying from cancer, but most hospices now have broadened their perspective and will look after patients with other incurable diseases such as motor neurone disease, kidney failure and heart failure. These still only make up a small percentage of our work at the moment, but things are changing slowly. Jean-Christophe Brunet: Is it possible to specify in one's will - or in any other way - that one does not want to undergo a post-mortem or autopsy after death? Dr Ros Taylor: Yes. In fact, it's a good idea to put in your living will, or advance directive, that you don't want a post-mortem if that is your wish. But the proviso is that you might legally need one if the cause of death is uncertain or if it's felt that you might have died from an unnatural cause, such as an accident. If that's the case, the death has to be reported to the coroner and it's the law of the land to have a post-mortem. Jay Creedon: My father has terminal cancer but refuses to talk about it. I feel that doctors and nurses (not the ones from the hospice) have been quite judgemental about this and have implied that there is something wrong with him or my family because of it. Surely this must be quite a common reaction from older men? Dr Ros Taylor: Everybody's different when they've got a serious illness - some want to talk, others don't want to talk. I'm upset to hear that some of the professionals are judgemental and perhaps you can actually take them aside and talk to them about why you think your father is the way he is. Lots of people find death difficult to talk about and everybody's got their own agenda. Caroline: I have very recently lost a very close friend of some 18 years as a result of a massive heart attack. I never believed that the pain would be so intense. Does it ever get any better? Dr Ros Taylor: I'm absolutely certain that the pain will get better but it's difficult to know how long it will take. There are lots of tasks of grieving, and it's about getting your feelings for that person in the right place. There's also lots of help available so why don't you talk to your GP, who might point you in the right direction? Jean-Christophe Brunet: How good are doctors at honouring living wills these days? Dr Ros Taylor: It's really valuable to know what a patient's wishes are in advance. It helps all the difficult decision-making at the end of life if you know what a patient's wishes are, and increasingly we have to honour a living will - but at the moment they're not legally binding. They certainly help me in my work to make the right decision. Penny: Do you think going to someone's funeral helps you grieve? Dr Ros Taylor: Yes, funerals are really the first task of grieving. By acknowledging separation and absence and the finality of death, people can actually move on and start to come to terms with what's happened. Funerals can be really uplifting as well as sad. Jane: What is the best thing to say to someone who has been bereaved? I never know what to say and usually end up avoiding it which is terrible. Dr Ros Taylor: The best thing you can do is just listen and often just not say too much. A lot of us avoid bereaved people because we're embarrassed, but in fact all the bereaved person usually wants to do is talk about the precious person they've lost. So listening is the key. |
