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

The Gold Coast Bulletin - - NEWS -

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.

Dr An­drew Broad­bent says Robina Hospi­tal’s Pal­lia­tive Car Unit is a lead­ing in­no­va­tor glob­ally.

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