Long time, no see.

Hey there peeps!
How are things?
Things have changed for me, at least in locale since my last pst - have another blog, but that is based on the move I made from the mainland of Australia to Tasmania - as you probably know.

I have recently been working in a new area of healthcare, which I really like, although, I do find it frustrating at times.  It has taken me a little bit, but as I have settled in, and on reading my last post here, one must choose to pick ones battles and stay classy and have dignity.  However, the ward I am working on now is palliative care, oncology and haematology.   These three specialities in one place creates its own confusion at times, but I am sorting it out.. slowly..  There are also issues in getting used to (STILL) the differences between private and public hospital systems.. Logic dictates (from a patient's point of view) that as patients (or patient's insurance) pay for a certain level of service, that more attention is paid to that service.. turns out that you actually get better value for your money if you go to public hospitals, it just isn't as well interiorly decorated ;-)  Oh.. and you get a cloth napkin with your meal in a private hospital *grin* (actually, you would be suprised how much that matters to some people!)

However, this is not the point of this blog.  I have always been passionate about an individual's right to refuse areas (or all) of their treatment.  I believe in an individual's right to die with dignity. but what I have recently come to realise, that your choices in medical care and interventions are a personal thing, like religion.  You might believe in a therapy that I might not. Doesn't mean that I don't believe you should do it, or believe in it, it is just that it is not a therapy that I believe in for me.  So, I have started to become aware of the fact that there are a bunch of people who manage your death, who, at times, have no real idea of the goals of care of, or knowledge of what is important to, those who are dying.  Once again TALK TO YOUR FAMILIES about what you want.. if you can't, write it down and include it in your important documents.

I know you are in the prime of your life, and you aren't ever going to die, but seriously, knowing what you want done to you in the event of you being unconscious is important.  Really think about what you consider dignified and humane, and where YOU draw the line. Sure, there are people who you need to consider, but honestly, not at the expense of your suffering and humiliation.  You do not earn points for stoicism and not asking for help when you need it.  And seriously, there is nothing dignified about being found on the bathroom floor at 3am, with your pants around your ankles because you didn't want to ask for help.

Now.. in true human form.. it is all very well to say this, but when you are actually faced with the reality of a diagnosis, I am pretty sure everyone thinks they will do everything to beat a poor prognosis - which is why it is YOUR own decision, and YOUR own belief.  Don't just tell your families and friends about your limits of intervention.. record it with your GP.  You need someone objective to reason through choices you need to make that are filled with emotion, and sometimes, those family and friends want what is good for them, not what is good for you.  Don't freak out on me - it is human nature to want the people you love to fight and stick around for a long time.  It is really hard to accept that a loved one does not want medical intervention, or even come to terms that there are no more interventions.

Because of my career, and a chronic illness that was a guaranteed early death when I was diagnosed (it isn't so much anymore - once again, don't freak out, peeps :-P ), I have nursing knowledge of interventions that are not for me. And it has recently come to my attention that I will also need a plan endorsed by my endo so my diabetes will not be mismanaged by someone who doesn't know my wishes.   The lip service of collaborative healthcare is thrown about, but the reality is that it is still very pedagogical and the assumption is that we, as healthcare workers, know more than you, as consumers, about your health.  And in reality, it isn't true. We know about stuff that we do to you, and what we know is not foolproof and it is not 100%. I used to say to Mike's doctors that they didn't need to be specialists in spinal cord injury, they needed to specialists in Mike. And now, I think it is true for everyone.  I have seen colleagues throughout my career become put out because someone knows what they want in relation to their care (may have even put out myself on occasion -I know! can you imagine?! )., and to be fair, it rarely has to do with the intervention, more about how the person makes the request or asks a question.. 

Hmm - I have strayed from my original subject - I should probably write more often, and stick to a topic each time!  I will endeavour to do this between here and there, so I don't rant on about random stuff.

So! think about your hard no's in relation to medical intervention, and let someone you trust to be objective when you are faced with making hard decidions know them, so that when you need to work it out, you can figure out where your limits really are in the face of reality.  I had typed a bunch more here, but I think that it is a subject for another post - I am making up for lost time, and have piled my soapboxes too high!  

Peace, love and mung beans, baby!