Everything End of Life.
This podcast is dedicated to talking to experts and others about all aspects of death and dying. You know, that thing we don't really want to talk about!
As a hospice carer and former psychiatric nurse as well as writer and former Theatre director, I invite guests to talk about their roles in and what to expect in the last four weeks of life. What happens to the person dying, what help is there, what to do before and after the event.
Many of the families we go in to see have one thing in common and that is that they don't know what to expect. I thought that a Podcast may help and then discovered so much to explore that is of interest to people such as alternative funerals, what do Hospices actually do, what role do religions play?
So join me for the first interview as we begin this Podcast with Clinical Nurse Specialist Becky Rix where we grasp the nettle and discuss what happens to us generally in those last four weeks.
Time to explore "Everything End of Life".
Everything End of Life.
A Candid Exploration of Life’s Final Chapter with Becky Ricks
This episode takes a deep dive into end-of-life care, exploring the unique challenges faced by both patients and families during the last four weeks of life. We discuss markers indicating the dying process, the role of compassionate communication, available support services, and the emotional aspects of caregiving.
• Understanding the individuality of each dying process
• Discussing the common markers that indicate the end of life
• The emotional toll on families dealing with guilt and confusion
• The pivotal role of the Single Point service for 24/7 support
• Clarifying the purpose of syringe drivers and anticipatory medications
• Exploring the different settings for end-of-life care and patient autonomy
• Addressing aftercare services available for bereaved families
For those interested in what Palliative care looks like at home there is "The Last Kiss" (Not a Romance)
Available on Amazon now
https://www.amazon.co.uk/Last-Kiss-Romance-Carers-Stories/dp/1919635289/ref=sr_1_1?crid=13D6YWONKR5YH&dib=eyJ2IjoiMSJ9._59mNNFoc-rROuWZnAQfsG0l3iseuQuK_gx-VxO_fe6DLJR8M0Az039lJk_HxFcW2o2HMhIH3r3PuD7Dj-D6KTwIHDMl2Q51FGLK8UFYOBwbRmrLMbpYoqOL6I5ruLukF1vq7umXueIASDS2pO91JktkZriJDJzgLfPv1ft5UtkdQxs9isRDmzAYzc5MKKztINcNGBq-GRWKxgvc_OV5iKKvpw0I5d7ZQMWuvGZODlY.fqQgWV-yBiNB5186RxkkWvQYBoEsDbyq-Hai3rU1cwg&dib_tag=se&keywords=the+last+kiss+not+a+romance&qid=1713902566&s=books&sprefix=The+Last+kiss+n%2Cstripbooks%2C107&sr=1-1
Hello and welcome to Everything End of Life with me, Jason Cottrell and guests, and my guest today is Becky Ricks, who was my boss for four years when I joined a team called the Virtual Ward, in which we went into people's houses and looked after them in the last four weeks of their lives. Hello, Becky.
Speaker 2:Hello Jason.
Speaker 1:How are you?
Speaker 2:I'm good, thank you, how are you?
Speaker 1:Yeah, now the kids are back at school, I'm just feeling tremendous. You know, it's like a weight lifted. We love having them, but yeah, I'm sure everybody who's a parent feels the same. Absolutely yeah, so today we're going to talk about the last four weeks Now. You were the boss of the virtual ward, kind of on and off a bit for about four years, is that correct?
Speaker 2:Yes, I was.
Speaker 1:Yeah, so you didn't just fall into that straight away. That was a kind of vocational thing, I think. So do you want to just tell us a little bit about your background and your history, where you started nursing? I mean, I remember you had a trajectory directly into, if you like, palliative care, from cancer research and other stuff like that. Yeah, so I started my nursing in 1996,.
Speaker 2:Yeah, so I started my nursing in 1996, worked at Essex County Hospital for 20 years, started on the wards working with which at the time we used to do a lot of chemotherapies, because the chemotherapy units weren't as large as they are now so and obviously not as advanced, and most people had their chemotherapy on a ward and it was over quite a few days, as opposed to how they are now.
Speaker 2:Because obviously research and everything has changed and chemotherapies have dramatically changed, thank goodness, and there's a lot more control over side effects etc and there's many more chemotherapies that people can have, which is brilliant really, because obviously it means that people's journey is sort of like extended considerably compared to what it was 20 years ago. So I did that for a number of years. Then I went from there into outpatients and did the outpatient oncology clinics and it was while I was doing that that I then had the opportunity to become a research sister. So I did clinical trials in in research. So we looked into different sort of treatment, sort of that people could have within their journey. We were involved in quite a few of the trials which led to some of the drugs now being used on patients, which was brilliant it's been really, really rewarding and I thought it was, and really interesting as well.
Speaker 2:It was a really insightful job. You know, got to learn a lot about, sort of obviously, not only diseases themselves, but also you know, the reasons why all these different treatments may or may not work, um, and you know. So that was quite, quite interesting, and we'd like to say we got involved in a lot of the several of the trials that um and now treatments that are standard treatments for patients, which is obviously really exciting and it's really, it's really um, interesting to have been part of that journey, which is great really.
Speaker 2:Um, and then from there I became so my manager at the time left um, and for a period of time I became the manager in the research, in the clinical trials unit, uh, and from there I then became a breast care nurse. Um, but also at that point it was I kind of realized that I wanted to be a secondary breast care nurse, so when patients' breast cancers have metastasised to other organs, I then sort of became the metastatic and set that service up and became the.
Speaker 2:I think it was no was it yeah, the fifth metastatic breast care nurse in the country, which was obviously quite sort of putting colchester on the map, really, which was good yeah, pretty cutting edge, I thought it was, um and sort of, did a lot of audits and things and found that the service was, you know, very beneficial and that's still running today, which is great.
Speaker 2:um, and when I was in that job, then obviously I, obviously I decided that I wanted to go a little bit further with the palliative and I did my palliative care degree at that time, which was obviously slightly difficult when you're at a later age, rather than doing it when you're sort of 18, 19 years, I've got to say I'll just stop you there.
Speaker 1:I know exactly what that's like because I did a BA in performing arts when I was about 30, and everybody below me was about 18 years old, 19, and I felt like such an old person, and I'm twice that age now, so I know exactly where you're coming from.
Speaker 2:It's completely different because you know you're not I mean, I hadn't done anything like that for many, many years. So, going back to doing the learning plus having you know three children and you know everything else that goes with it, it was a bit of a challenging time, but it was. It was good and it got me where I then wanted to be, which was working at St Helena Hospice as a clinical nurse specialist, which I did for a number of years I think it was probably about four or five years I did that and then, like you said, for the last four years it was working in the virtual ward team, which was obviously supplying personal care for patients in the last four weeks of life, which is obviously a job that I thoroughly enjoyed.
Speaker 1:Yeah, and that's where we met really, um, and my journey through that was I was not in nursing for years, for 30 odd years, and then, um, I had a little business distributing cooking oil and of course COVID turned up and nobody needed cooking oil because everything closed down. And so somebody said there's a job going in palliative care which, to be honest, even having been a charge nurse in psychiatry for a few years, I did not have a clue about what palliative care involved, what it was about, what a hospice does. And these interviews are really to help enlighten people like myself who didn't know anything about, or don't know anything about that side of life. So, yeah, that's how I came into meeting you, which was a delight, and we, you know, I started as a carer. I didn't want to retrain as a nurse, so I started as a carer and my learning curve for caring just was so steep, um, it changed dramatically since I was, uh, since I was a nurse all those years ago, and you must have seen that sort of kind of change as well, because if you'd worked at Essex Hall, essex Hall was a proper institution, you know. So there were things that came in that I'd not seen before, like the beds, the profiling beds, which are a mechanical piece of genius, you know. But let's just get back to that four weeks.
Speaker 1:So specifically, something happened when I was a carer, going into people's houses. One of the questions that would continually come up is I know you can't say, but how long have they got? My relative that is, and it was always a really tricky one. And I remember saying to you well, how do you know? Because, how do you have a clue? And you said, well, it's, it's experience, really quite a lot of it. But there are markers. So do tell us about the markers. I mean, what, how does that?
Speaker 2:well, I think the first thing to say is that obviously, everyone's dying process, everyone's death, is different. You know there isn't anyone that's the same. They might have similar sort of like patterns, but there is. You know. It's very unique to not only the patient but obviously the relatives as well. Um, so I think that's important to say first of all. But how do we know? Again, like you've just pointed out, I think just years of experience will make you know when that time is coming, um, and you can give people sort of pointers as to what to look out for, which may well be things such as getting more sleepy, spending more time in bed, which obviously the majority of the patients as you know, jason, that we had you obviously would have identified that as well that you know they might have been a little bit mobile, a little bit fragile and frail, have been a little bit mobile, a little bit fragile and frail, but a little bit mobile.
Speaker 2:When we first started going out to them and then you noticed yourself that they were spending more time in bed, they were very fatigued. You know extreme fatigue, and I think that's one thing that you know. It's not like oh, I'm just a little bit tired because I didn't sleep last night. It is literally the whole body is drained of any know. It's not like oh, I'm just a little bit tired because I didn't sleep last night. It is literally the whole body is drained of any energy and it's completely exhaustion, you know. And so someone won't want to get out of bed.
Speaker 2:And I think also one of the other major things which obviously is quite difficult for family members is the fact that the appetite reduces, so not wanting to eat, not wanting to drink and we all know that we're brought up that you know we eat and we drink to survive. So for a family member that's quite a difficult thing to come round to, um, in the fact that their loved one doesn't want to eat anything and they might be trying to, you know, sort of say to them you need to eat, you need to eat, you need to eat. But if they don't want to eat, then you know we have to kind of have those conversations with them that you know they're not moving around as much, they're not as hungry. They actually don't want to. They might not be able to digest things because of the fact that things are slowing down, um, and it's we found that there was a sorry.
Speaker 1:We found there was a, an element of guilt there, that the relatives would feel guilty that they weren't properly looking after somebody. They wouldn't have a square three meals a day, even though that appetite, as you say, was on the floor. Yeah.
Speaker 2:Yeah, and I think and again that goes back to the, you know, we are always, it's it's kind of like embedded in our brains, isn't it? That you know, know you have to eat in order to carry on, um, and that's very difficult, it's uh, that, I would say, is probably the most difficult thing for people to accept that they don't want to eat, they don't want to drink, and they know, then, that if they're not doing that, like you said, there's a guilt element that they should be eating and they should be drinking. But trying to have those conversations sensitively, obviously, is, you know, really difficult for families to accept. And they do feel guilty because they feel like if I don't give it to them, then I'm kind of helping them in a way. But it's not, it's nothing to do with that at all, and I, and also I used to hear people say well, if I sit and eat a meal, then I feel guilty sitting eating a meal on my own.
Speaker 2:Or, you know, there might be some people that have been married for many, many, many years and that's the one time we know with families, it might be the one time you all sit down in a day together and have a meal, and you know, with husbands and wives or partners, it may well be that once you come home from work, that's the only time that you really do sit down together, and if that person then isn't there to do that, again there's that feeling of I'm not doing what I should be doing, you know, and or should I be eating? Maybe I shouldn't be eating, you know, so that I'm like them and I'm not eating in front of them, and all of those kinds of feelings.
Speaker 1:I think it's that also, that break in the normal routine. The routine has been set for 20, 30, 40 years, whatever, and so that routine is very it's in itself a very difficult thing for some people to break and to see crumble in front of them, if you like, and have to put new routines in place, and that can be stressful by itself. It's almost like the grieving process is beginning there.
Speaker 2:In that last four weeks, yeah, and then it's that realisation, isn't it that, oh dear, we're at that point now and again, I think that that's where the support element, you know, really comes in, because a lot of it is the communication.
Speaker 1:they're talking to people, um, you know, and just being there to support them and to guide them through those really awful sort of times I'm gonna say it was a real privilege to be a part of that job, you know, to be able to go into people's houses and every home was different and every story was different. But it was a beautiful thing in many ways to be a part of that journey. And one of the things that we did used to which you really wouldn't kind of think, is there was a lot of laughter, you know, in many houses there was a lot of, you know, a lot of joy around that time, which is almost like the apposition of opposites. When something's really really terrible, we feel, you know, like, well, certainly, british humour, I think, comes out and people want to be supportive in a happy, joyful way, and people make more, more jokes perhaps, than they normally would, even the patients, quite often. I found some patients who were just, you know, comedic. They were just brilliantly funny, you know.
Speaker 1:And there was one, I remember, one chap who had a funeral as opposed to a funeral, and so he invited all his friends around. He knew he was going to go downhill within the next couple of weeks, so he invited all his friends around and they had a garden party and they had jugglers and they had a burger van and it was yeah, it was amazing sort of thing. So at that time it's not just all doom and gloom quite often, I mean, it can know really harsh in places, but I think there's a lot of joy out there as well at that time and I also think that the privilege of being in someone's house and seeing them on a regular basis, is that you become part, you become almost part of that family.
Speaker 2:You know they really rely on you, um, and they trust you, and trust is a is a huge thing in someone's end of life. You know they need to be able to trust the services that they have and the people who are there looking after their loved ones. So you do, I think being in people's homes because you are a guest in their home and again, that building up that trust means that they're happy to let you back in and to you know, to be able to support them. All is is very important it was.
Speaker 1:It was a beautiful thing actually when you I mean this happened on a quite a regular basis which we'd go in for a first visit into somebody's house, uh, and there would be one relative looking after another and they'd look really quite stressed and almost disheveled, if you like, from from having been caring, uh, being the sole carer for someone.
Speaker 1:And I remember the joy of going um in the morning and seeing them being kind of nervous their shoulders would be up here, they'd be. Oh you know, it's so much going on, I don't know what to do. And and then in the morning and seeing them being kind of nervous, their shoulders would be up here, they'd be. Oh you know, there's so much going on, I don't know what to do. And then in the afternoon they would be so much more relaxed, offering you a cup of tea and smiling, and just because they knew that support was there now, and there would be somebody there at the beginning of the day and at the end of the day and they had somebody to talk to and they had single point. Could you just give the word on single point and and what that uh entails, because I, you know I'm still in awe of single point.
Speaker 2:It's an amazing uh phenomenon. Single point is an amazing service and we're so lucky to have it here in this part of the country. Um, it is quite unique. I think other hospices are sort of running similar services, but Single Point is a 24-hour, 365-day-of-the-year telephone number that you can contact, where people will be there to help, to support and advise you. So when you ring that service and you can ring at any time of the night or day the telephone will be answered by one of the amazing call handlers and they will then put. They will get some details and then what they will do is they will put that on a triage list and then one of the equally amazing nurses will then be there to sort of look at the patients and to ring them up, advise them and support them and possibly either go out and do a visit for that patient or arrange for one of the district nursing team to go out and visit that patient.
Speaker 2:But I think the problem is, whenever anything is going to go wrong, it will always be after five o'clock at a weekend. Thing's going to go wrong. It will always be after five o'clock at a weekend and you know that's when. That's when it's the most scary times, and night times are really scary because you don't really know who to contact, what to do, um, and I think that's why single point is just as so fantastic. Really, it's a service that I just you know. Like you said, jason, I think without it it's, it would be, it would be not the same service. You know, I think that they are amazing at what they do so responsive.
Speaker 2:Yeah, um, and I think you know it would be disastrous without it, really, because it's such a great comfort for families, um, to be able to call that number and know that someone will be there to to help them in their hour of need.
Speaker 1:I mean, yeah, they're just an incredible bunch and I think we're I. There is another podcast called Everything End of Life, which is an audio podcast, and on that podcast you can find it on Spotify, apple, the whole nine yards. It's an it's an audio one, and we had Katie Billimore who talked all about single point. So if you want to know more about that, then you know, go on to Buzzsprout. I'm going to keep that going for another three months or so, just so people have an opportunity to listen to the audio versions of this. I'll also just punt my own little book here, the Last Kiss, not a Romance. So if you go onto Amazon and you're looking for this, put in Not a Romance by DJ Kutrol, because if you put the Last Kiss in, you wouldn't believe the amount of stuff that comes up. That is nothing to do with palliative care and it sort of covers what I discovered in that team working with this amazing bunch of ladies and it describes the visits and the kind of things that we used to do. So if you're interested in that, then you know. Last Gears not a romance, but you can still. There's also on the other podcasts, the audio podcasts, there's about 12 different interviews with different people, from funeral directors to celebrants, and a whole array of interviews with people talking about their speciality, because I'm, I'm pretty sure, becky that, um, like me, uh, you're amazed about actually how many different people are involved, and I know that when we were going into people's houses they would say, you know, they would get confused by all the different agencies going on. There'd be there'd be clinical nurse specialists going in, there'd be carers going in, different agencies going on, there'd be clinical nurse specialists going in, there'd be carers going in, there'd be doctors occasionally going in, there'd be therapists going in, and it seemed like a bit of a swamp of people coming to your house. And I think that's something worth noting is that the virtual ward was very good at being a friend to people and saying, well, this is that person, that's that person, this is what that person's doing here. Being a friend to people and saying, well, this is that person, that's that person, this is what that person's doing here, uh and um, yeah, so it's a, it's an amazing service.
Speaker 1:I wonder if we could turn just for a moment to some of the practicalities. So one of the things that, um, I I'd not seen. I mean, you see, uh, people with drips in hospital and, um, you know it's, it's a classic somebody walking around with a stand and a drip going, paying from there. But, uh, syringe drivers if we could just talk about those for a moment, because there's a few bits of myth and mythology about that and and the first, of course, you know and I'll say out, is that people, some people say when you get syringe driver, that's the mark of the end. But that's not how I understand it at all no, it isn't, and you're absolutely right.
Speaker 2:People always think that the minute that that goes in is when, obviously, things will dramatically change. Um, if you think about it in a different term. So if someone is, for example, taking a lot of medication for pain control and then they lose the ability to swallow, say, for example which can happen sometimes, or they haven't got the energy to take medication anymore, or they're not digesting it or absorbing it properly, then obviously it would be barbaric not to give them any form of pain relief. So what we would do in that scenario is that we would give a number of injectable medications to help with sort of pain relief and then, once we've done that for a certain period of time, then we would probably then consider starting up a syringe driver, which is it's a little box which has got a syringe attached to it and it has to be recharged. So a nurse has to come in every 24 hours and they recharge it. So that means that they would then put more of the medication into the syringe and that pumps out into the body over that 24 hour period.
Speaker 2:So you can use it for different things. So it can be used for pain relief, it can be used for anti-sickness, it can be used to help to relax people if they're a little bit agitated, and it can also help with something where, so, when people are in bed, um, most of the time, then they can get some secretions in the throat, um, and what happens is, because obviously people are highly fatigued, they don't necessarily have the energy to cough up that saliva, so it tends to just sit sort of around the throat, around the sort of upper chest, and then what you would need to do is to break that secretion down so that it's not uncomfortable or, you know, distressing to family members if they can hear that that's an interesting point.
Speaker 1:Sorry, I'm just going to break in. That is an interesting point Distressing to others. Because what we always noticed was it wasn't actually when somebody's got secretions. They're quite rarely themselves distressed, but that sound would you know. They'd be quite relaxed by that time. So you hear that kind of gurgle going on of their breathing, but it would be the relatives who would be more concerned, if you like, and I think that's one of the things that you know the syringe driver helps with. Correct me if I'm wrong, but it doesn't get rid of the secretions, but it arrests that progress, that development of secretions yeah.
Speaker 2:So it's to kind of dry up the secretions. So that's the whole purpose of that is to dry up those secretions so that it doesn't sound as distressing for relatives. And you're absolutely right, it doesn't seem. In all the years that I've been nursing it doesn't appear to cause any distress to any of the patients I've ever nursed. It's more for the family, if they can hear it. I mean, sometimes you hear it called the death rattle, which I don't like, but you sometimes do hear it called that but it is literally secretions that are sat here. So normally what we would do is we would swallow, we would cough and we would get rid of those secretions. But if you haven't got the energy to do that then, or if you're not sort of very conscious, then obviously that is going to just sit there, especially if you're laying in a bed. Um, it would just sit there and that's when it makes that noise.
Speaker 1:So it is literally just to try and dry up those secretions, to break them down I think, um, it's also worth mentioning that, uh, there is a whole bunch of there's basically about four anticipatory meds and they come in a bag and the that's prescribed. When somebody's saying, well, okay, we're looking at the last month, the last couple of months, then somebody will, um, have a gumption to order the anticipatory meds, so they are in the house, ready for that part of the journey yeah and I think it's.
Speaker 1:That's such a reassuring thing for a lot of people, is they? If it once is explained to them, that's what they're there for if there's a problem, or if they're required and they're not always required, and a syringe driver is not always required, um, but uh, they are there, ready for that eventuality yeah, absolutely, and you know the clues in the name.
Speaker 2:They're anticipatory medicines. You know, in anticipation of when that time will come, that they may well need to be used, and nobody would ever sort of start a syringe driver without talking to the family, explaining what they're for, explaining why we're starting them and having those kind of conversations with family members.
Speaker 1:Yeah, I think that's an interesting thing you just brought up. There is about the conversations, because and it takes quite an experienced person carer, nurse, doctor to have that conversation, to be able to use the terms yeah, your relative is dying. You know they're not. This is not, this is not something we would talk around fluffily. I remember you coming into one of the patients once and saying to him look, you know, we have the thing called the DNAR do not attempt to resuscitate. And you'd kind of asked him if he would be okay with signing that. And he was saying well, look, you know, there's lots of things I still want to do.
Speaker 1:But he was in quite a poorly way. I mean, there was no getting away, probably got a week, you know, left and his wife was sitting there and the conversation went along the lines of yes, but if you have a stroke or a heart attack, then that's going to leave you in a much more debilitated, um uh, condition and your, your wife, is going to be finding it even more distressing to try and look after you because you know that you're going to be dying. And to be that blunt to somebody to have to say you know that takes, I think, a special kill and actually he was really lovely because in the end I think he did sign it and he was kind of okay with that. But that conversation, you know, must take years of experience to be able to measure somebody's reaction and how far you can go with that and think that's something I observed in you and I've just seen a big compliment because that was just amazing, you know.
Speaker 2:I mean, oh crikey so I think one thing just to sort of say to you is that a patient doesn't sign a, do not resuscitate. Um, it is something that a clinician would do, so it do not.
Speaker 1:Yeah sorry, yeah no that's right.
Speaker 2:it's just because people do often say, well, I never signed anything, so I thought it's important to say you don't actually sign it.
Speaker 2:It's the clinician that signs it, but you do it with the patient's consent or a family member, depending on, obviously, the situation. So they should be very sensitive conversations, obviously. Sometimes, unfortunately, like a lot of things in life, they're not done, maybe in the way that they could be done. But it is always better to have those conversations with the patient themselves and to kind of help with their planning a little bit about what they want, want, um, I think the hardest part is to kind of come in when it's too late and then try and make all of those kind of decisions because then obviously you have to then ask the family members what they're what they would want that you know for the patient, or what they know the patient would want, and it can then sometimes be a little bit more difficult.
Speaker 2:So I think the more planning you can do when it gets to that situation is the better really. And I think the important thing about the do not resuscitate is the fact that you know we would. It's only when the heart naturally stops that then we wouldn't attempt to do that resuscitation. So it doesn't stop anything else. And I think that's the one thing that most people fear is that when you've got one of those that people are just going to say, oh well, he's got to do not resuscitate, we won't bother giving him anything.
Speaker 2:Um, yeah and that's not the case. You know, if you needed antibiotics or you know if there was a reversible cause, then of course we would be doing that. It's only when the heart naturally stops. If you've got to do not resuscitate, that we would then say, okay, he's got to do not resuscitate, let that. We would then say, ok, he's got to do not resuscitate, let's, let's just let him naturally die. You know in a natural way, rather than trying to be heroic and try and do anything that would actually not be in their best interest.
Speaker 1:So what we're talking is, if somebody is dying but they get a chest infection and yet that's treatable, is dying but they get a chest infection and yet that's treatable, yeah, then that that is something that you would continue to treat absolutely, and uh and the same with anything of that nature that's there to make the patient more comfortable yeah, absolutely.
Speaker 2:Any reversible cause or anything that we think we might be able to reverse, then obviously that would certainly happen. And I think that's one thing that sometimes if that conversation isn't held correctly, then that is one thing that people do fear that the minute I have got that, do not resuscitate in situ. Does that mean that that's it, that you know everyone's just going to go well, we're not going to do anything now? And that is where that is incorrect, because it is nothing to do with that. It is just purely about your heart naturally stopping let's see.
Speaker 1:So that's something. Definitely, I think you know I wanted to clarify um and and to talk, but also to say, um, that it's it's got. It's got to be a great act of compassion to be able to sit with somebody and have that conversation, because you're there on their behalf, their family's behalf, and framing exactly you know what is likely to happen and what could go wrong and what could go right. So, yeah, just having that conversation, I think is a compassionate thing all by itself. So just I think to I think probably we ought to round off really, because we just, you know, I've talked with you for ages about this, because it was such an amazing team and such an incredible job to do. But just I think, just to round off, we ought to maybe talk a little bit about general services for people when they're coming to end-of-life care.
Speaker 1:There are so many other support services apart from the virtual world, which the virtual world doesn't exist in its former form because of funding issues and all sorts of problems. But there are. You know, my father-in-law died up in Sudbury direction and they had a hospice up there who goes to such a very similar service. So I think, you know, it's not peculiar to Colchester or it's not peculiar to St Helena to have those great teams in place. That should be, I think. Correct me if I'm wrong, but I think that's something that should be a basic standard of all palliative care that should be available to people for free. But then I'm a socialist, if you like, in that respect. But yeah, so what other services do you think are out there that are going to be useful to people? I mean, we get to a certain point where the patient dies and we withdraw from the virtual ward, but we don't entirely, because there's aftercare for the relatives as well. Is that something you can talk about?
Speaker 2:Yeah, so within hospices and I know we're not unique in this there are different services that can help, obviously, along the whole journey really. So you did mention earlier that you've got therapists that go out, um, you've got chaplaincy that will go out. You've got, um, lots of different. So your district nurses, your GPs you know there are lots of different services involved within. It's not just all at the hospice. There are a multitude of different people that get involved when someone is at home and everyone has to work together in order to make that journey as best as it possibly can be. So we need the GPs so they can prescribe the medication. We need to keep the GPs updated with things. We need the district nurses to help, maybe to order some equipment to help with pressure area care. We need them to help with sort of syringe drivers, anticipatory medications. As well as us.
Speaker 2:We need, obviously, people have strong faiths, or sometimes people find a faith at the end of their life, so they want chaplaincy involved.
Speaker 2:So at the hospice, obviously they've got a great chaplaincy service, but also with all of them we've obviously discussed this with the sort of strains that the family members have, as well as the patients. There's obviously the counselling and services which obviously are used quite a lot within the hospice um, but also obviously, like you rightly said, when someone has then gone um, it's about those services carrying on. So one thing that obviously when someone is dying, as you said earlier on um is that all of a sudden the house becomes a bit of a thoroughfare for everyone coming in and out of the house. You know so you've got maybe district nurses, gps nurses, carers, lots of people coming into the house and then when that person has died, all of a sudden everyone goes and that can be a really lonely time for people, especially if it's a husband and wife or a partner and partner who maybe haven't necessarily got a big family, um, who don't really have very many other people in their lives.
Speaker 2:And we used to see that quite a bit, jason, didn't we? Where you know, it had been them and it had been them for many, many years, and actually they didn't really have a big kind of social network and then and they loved it that people were coming in and out, um, and then when that's not there anymore, that's a very lonely time. And obviously mental health is a big, huge thing nowadays, um, rightly so, um, but obviously with, with bereavement, that can have a huge impact on people, maybe not even necessarily straight away, but then maybe afterwards or in a year's time. You know all of those things and that's where, obviously, bereavement services can come into play as well that.
Speaker 1:So, listen, I want to say a big thank you for coming on and doing a video podcast with me.
Speaker 1:Uh, I think you know I'm hoping that this will be a series of interviews with different people that will help people to understand that whole end-of-life thing, because we don't we're not great at talking about it, but I kind of think it's not because we don't want to talk about it, but it's like you don't talk about the holiday you're going to have in three years' time because it's not because we don't want to talk about it, but it's like you don't talk about the holiday you're going to have in three years' time because it's not in your sights, it's not something that you're really concerned about, because you're thinking about this year's holiday.
Speaker 1:So I think there is an element where some of us are okay talking about it, but we're not prepared when it comes, and it can come quite quickly sometimes. So, and there's also an interesting thing is to say there is a cultural element of this as well that, uh, we you know a lot of the ethnic minorities that we have in this country we don't see in hospices, because they have a different care system almost within their little communities, their societies. So it's interesting to note that. But um, and I'm sure that's something you must have noticed- yeah, absolutely I mean I was just gonna.
Speaker 2:I mean obviously, yes, there definitely is. I used to do quite a bit of work with the nepalese um, so it's sort of like um culture and obviously the way they do things is completely different to the way we do and obviously we have to respect that. You know, with whatever that may be, we have to respect their rights, their wishes, and also we're quite a diverse community. You know, nowadays things have changed quite a lot. The way we talk about things have changed the way, and I know that's certainly from you know, all my years of nursing, which I'm sure you do too, jason that obviously the way that we talk to people has to be so different now because of the different diversities that we have out there, um, and you know, and it's ever evolving as well, um, yeah, and I think we have to take that into consideration. But I think also the other thing I just wanted to say before we do finish, jason, is that obviously not everyone wants to be at home.
Speaker 2:So I think that's the other element to think about is that sometimes they want to be in the hospice, which obviously has got the inpatient unit. So sometimes they want to be there because they don't want to be at home, for whatever reason, maybe because they don't want to upset family members. Um, because family members say that they don't know that they could cope with their loved one being at home or, you know, worries about if they've got pain. Would they have someone that could be with them straight away, which, as we know, can't happen instantly. So there are lots of other sort of places that people can be. They can be so obviously we've discussed at home. They can also be in the hospice inpatient unit if they have the capacity to take someone or there's nursing homes, if actually that's the right place for them to be with support.
Speaker 2:Um, and also hospital, and I know that most people say, oh, no one would want to be in hospital to die. Having now working in the hospital, I have to say that I've only seen care and compassion for people that are dying in hospital. They will always try and get someone a side room so that their family members can be with them. The staff treat them with compassion. They will go above and beyond to help patients, so have the support from the hospital palliative tech care team. Um, you know. So I think that it's not, even though I know that's what we're talking about.
Speaker 2:It's not all about being at home it can well, absolutely not different sort of in a different situation it's very unique to the person, whatever the person or the family members would like yeah, my sister died in hospital two years ago.
Speaker 1:Uh and and I'm I'm sure everybody gets this like buses my father-in-law died as well, and uh and uh, my uh daughter had, uh, in the same month one of her friends die, so they just came along. But one of the things that I was really surprised there because I thought she would want to, um, die at home is that in the end she was.
Speaker 1:She did want to go home first, but she felt much safer actually in the hospital and therefore, that's where she eventually she said well, no, no, actually I want to actually stay here because I feel safe here A testament to all the staff on the ward for that one, you know, because, yeah, they did an amazing job. They did an amazing job Anyway, all right, listen, becky, it's been a pleasure to talk with you again. I know you've moved on now from the hospice to a new role. Just tell us, please, just tell us a little bit about that role.
Speaker 2:So I'm one of the lead nurses in the transfer of care hub at colchester hospital, um and we. So one of the main elements of my job is working with um, a team of nurses, leading a team of nurses to try and get people out of the hospital into their preferred place of care. So we work alongside the palliative care team and we try and see if we can get patients out as quickly as we can if that's what their wish is. Again, obviously it's not always a wish, but if that is their wish, then we try and get them to wherever they work they want to be. So we work with the commissioners to try and get, obviously, socially funded care packages. We also work with adult social care um for socially funded um and we can advise and support patients and their relatives as well. So that, in a nutshell, is is what our job, my job, is currently that's brilliant.
Speaker 1:Now, would you be willing to come back in about a year's time and talk a little bit more about this kind of this area if not at the end of everything, end of life, um, about the compassion that there is just generally around the hospice and the hospitals and in this line of work, because I think it's fascinating. A lot of people will say that nurses are angels. Well, I know quite a few that are not really, that can be just as grumpy as everybody else, but the basic wanting to help other people. I think that is something that we all kind of share in a line of compassion. So, listen, would you come back in a year? Yes, I certainly will.
Speaker 2:Thank you very much. Yeah, just in case I run out of people to interview.
Speaker 1:really, would you come back in a year? Yes, I certainly will. Thank you very much. Yeah, just in case I run out of people to interview. Really, you know? No, I'm kidding, I'm kidding, thanks. No, it's always a pleasure, as you know, and we always thought you were such an amazing boss to that particular team. So, thank you once again and we'll end it there.
Speaker 2:Thank you very much. Thank you, jason, and thank you for asking me to come and talk.
Speaker 1:No, it's been an absolute joy again. All right, cheerio.
Speaker 2:Thanks, Jason Bye.
