Making the most of life in final days
Palliative care is about living, and Robina Hospital’s Dr Andrew Broadbent takes great satisfaction from the creative side of helping on a physical and emotional level
THERE are snipers positioned around Robina Hospital. There are armoured cars on standby, multiple officers on guard, police dogs straining at the leash and guns are loaded. All of this prescribed by a doctor.
It’s not going to cure the patient, but it is going to help give him a better, even a good, death.
Director of Palliative Care Dr Andrew Broadbent knows that all of his patients will die – that’s exactly why they are under his care.
But what care it is.
His job is not just to help them die, but to help them live. Which is why the palliative care ward, contrary to popular belief, is not shrouded in grief and silence, but echoes with laughter and parties. Weddings, birthdays, holidays – all are celebrated in this ward of the dying. “There are two things that I ask every patient at the first consult,” says Dr Broadbent. “The first is what are you most worried about? Sometimes it’s ‘I’m worried about my wife’, or ‘I’m worried about my children’ and for others it’s their dog.
“My first priority is ensuring those anxieties are relieved, we help put plans in place so that they don’t have to worry about that anymore. “Then I’m asking, how can I, as a doctor, help you? I don’t go in and say ‘we’ll fix all this, she’ll be right’. We try to figure out the best way to help them achieve their goals – sometimes that’s a focus on symptom control, but sometimes it’s a focus on how to achieve their bucket list.
“For example, someone might dearly wish to fly to London to see their family or just because they’ve always wanted to get there. They might think they can’t go because they’re sick but that’s where we say, ‘well, maybe you could’.
“We organise support at each end and talk to the airlines … we’re like a little make-a-wish foundation.
“That’s why we have our beach wheelchair … so many people their last wish is to get back in the ocean – it’s a floating wheelchair.
“We do weddings on the unit, we do Melbourne Cup, we do Christmas – twice a year actually, in mid-winter and in December.
“Generally doctors try to fix things … if we can’t fix it, we want to help. You can’t cure everyone, but you can help them.
“We’ve had people where their one wish is to see a family member in prison. They can’t get to the prison, so we bring the prisoner here to visit their dying loved one. Some come from Wacol, some from New South Wales.
“We’ll have snipers around the hospital, the police come with their dogs and cars and guns and, yes, it can be intimidating but we are here to help and we do everything that we can.”
It’s one of the reasons that Dr Broadbent says he’ll never practise euthanasia.
He says he accepts that it will eventually be legalised – and he’s OK with that – he just doesn’t want to be the one practising it.
“Palliative care is where I belong, I want to help people live all of their days in the best way that they can.”
However, he says his job is often complicated by the fact that while the Gold Coast may be one of the best places to live, historically it hasn’t been the best place to die.
He says the city’s high level of migration means a large proportion of our population are without family support, while the traditionally transient community means that social support structures are also less available here than in other cities.
“We don’t have a lot of the social supports here like Lions Clubs, Rotary, church groups, extended family groups that you have in cities like Melbourne and Sydney where generations of a family have lived,” he says. “Many of our residents have only moved here in the last five years – I’m one of them.
“A lot of our patients are not cash rich, they’re not asset rich either and they’re not family rich, nor are they community support rich. As you get sicker and need more support, they have nowhere to go but to hospital.
“About 80 per cent of Australians have said their preferred death is at home, surrounded by loved ones. In truth, only about 20 per cent achieve that. Here on the Gold Coast that percentage is even lower.
“We’re trying to improve that, though. Over the last couple of years, we’re getting close to the people linked to our service and our home death rate is increasing – it’s doubled, even tripled. But that’s not everyone on the Gold Coast, just the ones linked to our service.”
Dr Broadbent says while he’d dearly love a giant bucket of money to fund his patients’ bucket-list wishes, his greatest asset is the team he leads.
He says while many people view palliative care as a depressing field, he finds it the opposite.
“We’re not here to help people die, but to live. I love the creative nature of this job and the team mentality,” he says. “Palliative care by its nature is creative, none of our patients exhibit the same symptoms, some have cancer, other respiratory issues, others cardiac … but they all need our help.
“We make things up as we go, we just have to get what we have and put it together and go, ‘will this work?’ Sometimes it works for a few weeks and then we have to rethink it, whether that’s a matter of medication or simple support.
“Of course we need more funding, our service has been completely outstripped by the growth in population, but I’m constantly amazed at how we deal with it.”
In fact, Dr Broadbent says the palliative care unit is actually a world leader when it comes to innovation.
As well as adopting the Telehealth patient consultation system, the unit is introducing virtual reality components to treatment, is hosting international conferences and has even developed the world’s most popular palliative care app.
Telehealth, an online patient consulting initiative, has already made a difference to hundreds of Gold Coasters in need of palliative care since its introduction in March 2017, allowing doctors to quadruple the number of patients they see each day.
“It’s essentially like FaceTime, we have a nurse who attends to the patient at home but the doctor is in his office. It’s hugely successful.
“We’re also introducing virtual reality to the ward. We’re using it for those bucket list items that we can’t do practically. If a patient wants to visit caves in Italy, we can give it to them via VR.
“The Gold Coast has come so far. We were this awful brown box hospital and now we have this amazing tertiary building. We don’t have all of the money but we can still be world-class. Next year alone we’re hosting a hospice conference and our first annual international palliative care conference in June. Not in Brisbane, but here.
“We’ve even authored the most popular app in the world about palliative medicine – more than 10,000 people use it. It’s aimed at GPs and generalists and it’s being picked up around the world, it’s just about to be translated to Japanese.”
At the heart of his job, however, is the patient.
Dr Broadbent says it’s a lesson he learned after his grandmother was diagnosed with ovarian cancer.
“I remember shopping with her here at Pacific Fair, we were on the Gold Coast for a holiday and she just couldn’t get her breath at Myer.
“She went home to New Zealand and was diagnosed. I was in my final year of medicine and the first thing I did when I graduated was to go see her. She was just so sick. I had to take her to hospital and she died a week later.
“To this day, the patients who affect me the most are those who remind me of people I know and love, like my grandmother. But it’s important to keep that emotional connection. I have ways of dealing with the grief and the stress – family and sport are two of the best, but we never want to be numb.”
While it may not be a miracle cure, it’s that emotional connection that helps Dr Broadbent turn his patients’ dying days into some of the best days of their life.
That, surely, is a miracle.