Science and soul

By Deanna Hutchings and Coby Tschanz

Health professionals and volunteers in Island Health gather five times a year to participate in the Education Series for End of Life Care.  The series has been co-sponsored by Victoria Hospice and the Vancouver Island Health Authority for ten years.  On October 6, 2014 over 30 people from twenty sites learned about “Trends, Tools, and Tensions of Palliative Care.”  This session involved a presentation on medically assisted dying by Dr. Douglas McGregor (Medical Director, Victoria Hospice Society) and a review of hospice palliative history, innovations, clinical tools, and education resources by Deanna Hutchings (CNS, End of Life Care, Island Health). As usual, the presentations and ensuing conversations were lively and relevant to health care in many settings.

The modern palliative approach is a relatively recent approach in healthcare, and its science is growing ever more robust. During the October 6 session, participants were encouraged to explore the science of palliative care in a new way during an expressive exercise that prompted study of the now familiar Palliative Performance Scale or PPS. The PPS is a tool developed at Victoria Hospice that gives a snapshot of patient function, based on the criteria of ambulation, activity/evidence, self-care, oral intake, and consciousness.  The scale is from 0 to 100% in 10% increments.  For example, a PPS of 30 % means that a person is totally bed bound, unable to do any activity/has extensive disease, requires total self-care, has a normal or reduced intake, and may be fully conscious or drowsy to varying degrees.  Professionals and volunteers here and around the world, use the PPS to communicate quickly about the health care—physical and psychosocial—likely needed by a person “at” at particular PPS, and to track a person’s condition over time.  But, as participants at the Series learned, the PPS has other uses!

In a learning activity facilitated by Deanna Hutchings and Coby Tschanz (RN, Victoria Hospice Society; Assistant Teaching Professor, School of Nursing at the University of Victoria), participants were invited to experience the PPS from a personal and poetic perspective.  The poetic activity facilitated an exploration of assumptions about living and dying.  Each participant in the series chose or was “assigned” a PPS to contemplate in depth.  Coby then read out a dozen stem sentences such as,  “If you described 40% as a sound, it would be _______”, which participants completed.  The idea was to capture a first impression.  Here’s an example of a poetic description based on a PPS of 40%.  

Sound: A light patter of rain-a soft melody, rhythmic and enjoyable not quite in the back ground but also not overpowering
Season: Autumn-changing, beautiful, full of color but fading
Taste: Oatmeal-nourishing, bland not spicy but wholesome with healthy benefits
Feeling: Gritty-knowing the future but wanting to challenge the outcome
Mode of Transport: Bicycle-still moving and able to go the distance, slower paced but capable of bursts of vigor
Time of Day: Late afternoon-diminished light, end of a full day, tiring but still engaged
Flower: A fading rose-still holds its beauty and aroma of a lovely life
Weather: Overcast-not gloomy but muting the light, quiet, reflective, changing
Type of Clothing: A gently worn overcoat-familiar, comforting, may be tattered but still treasured
Body Part: Aging hands- wise, strong, gentle, caring. (Carla)

Lastly, participants left their list as is, or were invited to draw from those phrases to create a poem to share with a participant sitting nearby.  Janellen wrote:

It's me. I'm here.
Please see me; notice me.
I'm weak; I'm failing.
It is Autumn, but feels like winter.
I smell lavender, as a submersible takes me down.
A lily I see; simple in its beauty.
The sky is hazy; diffuse.
A plaintive oboe strokes my heart.
A string of pearls is soft in my hand...

And so, participants at the October End of Life Education Session experienced a blend of both the science and soul of palliative care. As one participant wrote:  “Unexpectedly, I enjoyed the poetic exercise; it was a great stimulus for conversation about our work.”

Quality palliative and end-of-life care for all: Our mission is to enhance the quality of life for those facing life-limiting illness, death and bereavement through patient and family centred care, education, research and advocacy.