to my surprise, i have been learning a lot about palliative care sitting in the lung transplant clinic.
i started my research fellowship back at the mothership a fortnight ago. my project aims to explore the experience and needs of patients and carers on the transplant journey. my hypothesis is that there are unmet palliative care needs in this population and, if so, the other part of my fellowship is to figure out how best to meet these needs.
i had worked as the transplant resident a few years ago. it was exciting and challenging but i was distracted by my exams. nor did i spend much time in the clinics, as i was always swamped by work on the ward. as i discovered on my oncology term during advanced training, life in clinic is very different from life on the ward. people are positive, energised and keen to live; rather than resigned, exhausted but afraid to die.
it turns out that a lot of what i think of as 'palliative care' is already being practiced in the lung transplant service: discussing prognosis. exploring psychosocial issues. determining goals of care. bolstering hope in the face of death. i am left wondering: perhaps there is no role for palliative care here. maybe ian maddocks was right and palliative care is just good medicine.
but here and there clues appear, suggesting that my radar has not been completely off and the unease i felt years ago was not entirely unfounded. refractory symptoms abound. verbal and non-verbal cues are left unheeded. distress is palpable in the air. this is the natural habitat of a consultation-liaison palliative care physician. this is where i am needed. i can feel it in my bones.
and, most of all, the patients and families and clinicians i meet tell me they want help with the things that i do every day. they may not call it palliative care. they may not even know what to call it. but they seem to sense that things can be better and place their confidence in me to make it so.
i suppose i'd better not let them down.