Halfway through the week I did had my day off which was needed.

It’s relatively rare that we have to palliate 2-3 patient in a week and despite finally making the decision within the team together with the patient and family it is still “stressful”

For the family and the patient to come to terms with a life ending problem and to give them the time and support they need to get through the difficult time.

From my point of view the work doesn’t stop there. The Just in Case (JiC) need to be arranged. Depending how long we have cared for the patient a discussion with the palliate team is needed – mainly for them to see the patient and the family and give them support and for me for some guidance on some of the medications.

JiC meds are a powerful set of medication to ensure the patient which is dying is comfortable and not in pain or distressed. We are using an electronic medication prescribing system in out hospital – which still in the UK despite being the 21st century – is not that common.

This medication prescribing system has order sets. A combination of medication for certain scenarios in the hospital. For example our team has an order set of all the post bariatric medication needed (Vitamins & Minerals, VTE prophylaxis, PPI etc.). The same is for patients who are at the end of their life – I click on the order set and the most common medications are displayed including their strengths.

Most of the time I still have to adjust the dosages to the needs of the patient. It’s a fine art to get those right hence a good discussion with the palliative team is usually the best way.

This can take some time and in addition – as usual – paperwork need to be completed or changed. The TEP form being one of them – Treatment Escalation Plan

This a a form which we discuss with every patient if they would like to be resuscitated or not during the hospital admission. The majority of discussion around this form are straight forward however in cased of terminally ill patient at the last days of their life it’s not that easy sometimes. Decisions have to be made regarding escalation to the Intensive Care Unit (ITU) or just ward based care, should we give IV fluids and/or antibiotics and if so when do we stop them etc.

So not only do we discuss the life ending event with the patient and the family but also how long are we actively treat our patients. This is an exhausting process for everybody involved!!!

A good death is important and therefore the process we have in place with this is pertinent.

I did read recently: ” A good death does honour to a whole life!” and I do agree with that hence getting it right key.

The other ward jobs needed to be done as well – pressure from the bed manager as there are no bed in the hospital. Bed pressure in the UK is chronic and at some point I probably have to write something about that.

One emergency surgery patient from the weekend unfortunately had to go back to theatres due to an anastomosis leak and I have put the patient on our Mortality & Morbidity (M&M) list for discussion at our next meeting.

Since the beginning of the week we managed to get our list down from 30odd patients to about 10 with further 4/5 patients being discharged. Hard work to do this and people who work in this industry know how hard it is to get everything done in a day!!!

Hence during my days off I hardly do anything when our son is at school!!!!!!!