Helping to shine light on patient’s final days
“NOT all deaths are easy.” Those five words hang in the air for a moment. It is profound to think about, sitting in the lounge of the Robina Hospital’s Palliative Care Unit, where those on death’s door come to spend their last days. Doctors, nurses, family, friends and support staff walk the halls with an almost silent reverence.
MAUREEN Tapfield’s hands are soft as she takes yours in both of hers and gives a reassuring squeeze, enveloping you with warmth.
She is softly spoken and has a calmness that puts you right at ease.
You do not have to spend long with the nursing unit manager of the palliative care unit at Robina Hospital to know you have met one of the truly good people.
Like death, working around it is not easy.
It is taxing, but it’s a price the men and women who wander the halls, supporting families through one of the most vulnerable times they will ever experience, are willing to pay.
“Not all deaths are easy, but the opportunity to support that end-of-life journey is very important,” Mrs Tapfield says.
“The staff are very passionate. Compassion, empathy, trust, respect, we’re able to really support that for the patients.”
The journey to the palliative unit is an emotional one. Staring death in the face and coming to terms with it is a discussion held early.
“Discussions are held all through their journey. It’s much better for the families and the patients to be referred to palliative care early, so we can establish a trust and understanding.
“We often get requests from people to come and have a look at the unit, ‘what are the rooms like, what’s it going to be like’, so there’s an opportunity to talk through that.
“They are often very relaxed when they see the garden, because it is something they haven’t had an opportunity to enjoy for a long period of time.
“Often you’ll see the family come in. If it’s end of life, The garden – where families have barbecues, where some spend their final moments in the sun, or looking out at the stars, the sound of water flowing – has a calming effect. At this time of year Christmas decorations adorn the unit, but for everyone in the 16 beds it will be their last. reports
they’ll come into one of these rooms and the family will immediately go and sit outside.
“It’s comforting to know they’re very close, they can be part of the patient’s care, or they can just have time out to listen to some music.”
THE JOURNEY
ANYONE who has ever lost a loved one after staring death in the face for a long time knows how it hangs in the air. It is consuming. Death does not discriminate and the unit sees people from all walks of life – young, old, those suffering long battles of terminal illnesses, cancer patients.
From the moment a patient enters Ms Tapfield’s unit, the goal is to support them through that journey.
It is more than just medical treatment. Much like Mrs Tapfield’s hands, the unit envelops them in warmth.
“The psychologist is a great asset to the service. Our advanced recreation officer often will cook a dinner for the family if they have a special memory around that.
“We had a Maori family who wanted to smell a cake their mother and grandmother had always cooked. We were able to cook that on the barbecue, and they all participated in that. It was a really special time.
“We try to make it so that they feel as though their loved one is being cared for to the best of our ability, that they can participate with the patient’s care. Sometimes that’s difficult because it’s very confronting. They don’t have to be a nurse or a doctor, like they have been at home, they’re able to just be a daughter, a son, a mother, a wife.
“When a family comes into the unit there is often that fear of ‘will we ever be able to take nan, or dad, or mum, or their son home’.”
In a throwback to the unit’s heritage, patients are given a heart that can fit in the palm of their hand.
“Each heart has a button. When a nurse does an admission and gives a heart, they’re handing our trust and respect to the family and we’re recognising that this is a privilege to care for that patient. We have found that has been of great support to a family.
“In the original part of the hospital – when it was put together by the nuns, the St Vincent group Sisters of Charity – the sisters used to give a crucifix that was bent that could sit in the palm of the patient’s hand, when there were times at night or during the day when they would be fearful of dying.
“Now being in a multicultural diversity, we need to be mindful that we cannot do that anymore, so that’s where the heart came from.
“It fits in the patient’s hand, often nurses will find it under the patient’s pillow and it also becomes part of the patient’s tapestry and journey with us. When the patient passes away, the family sometimes takes that as a comfort that it was part of their journey, it was part of them.”
In death, like in their final days, the way a patient is treated has been considered and is treated with a final journey through the unit.
“We also have a coverlet, some of the patient’s family were requesting to walk with us to the mortuary. That was quite confronting.
“The trolley would come and there would be a blue cloth that sits over that, a cover, because the mortuary is quite a way out from the unit.
“We decided that didn’t offer a lot of reverence to the
Maureen Tapfield (above), nursing manager Robina Hospital palliative care unit family or the staff. Often we’ve been through some really difficult times with the family and the patient. Our respect is to recognise that this isn’t just a process, it actually recognises the life that was and there is a celebration to that life.
“A voluntary group, the Quilters Guild, made a coverlet. It sits in a case and is brought out when someone dies. On the quilt, it has the hands of the staff in a wreath that sits in the centre. In the middle of that is a spray of wattle.”
Once the coverlet is placed on the deceased, they are taken through the unit, as everyone stands aside on their final journey.
“We switch on a candle and everyone stops. The coverlet is taken from its case, it’s then passed over as the mortuary attendants come up. We place it over the deceased. The family, if they wish, then walk beside us. Often they can have a long journey, so we walk to the lift which is about halfway down the corridor and hand over care to the mortuary.
“The quilt is then passed back ceremoniously and returned to the ward. For families that have experienced that, it’s a very moving time, it’s quite powerful. Everyone recognises that and will stand aside as we pass through.”
THE PEOPLE THAT HELP IN THE JOURNEY
IT isn’t easy, this journey. The staff wear their hearts on their sleeves. It’s hard not to become invested in those people who have graced the halls of the unit.
“Everyone has their own tapestry and the staff become part of that tapestry for all of them. I’ve worked with them now since 2010. They all align with the values we share every day. They see this job as a privilege.
“Nobody says the journey isn’t difficult, but they really work.
“The social work side of the team is amazing. They have much to deal with and particularly with the fact that there are a lot of social issues with families.”
The grief process can be confronting and it is important for Ms Tapfield that her staff are in the best place to deal with that.
“We try to work that so we are very much aware of supporting our team, so we can keep that journey and that tapestry real and precious for the family.
“If we don’t get it right, because sometimes the journey and the dying is quite difficult, it makes that next step, because grief has not time to end. It can go on forever. There will be a part of that person that is missing.
“The ability to support the staff and the family to do that and to do it well, is very important.”
Ms Tapfield can’t speak for everyone in the ward about death, but when asked if she looks at it differently, there is a long pause, followed by an extremely considered answer.