Opinion

Ever considered a career in palliative care?

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As a nurse consultant in palliative care, I see people at their most vulnerable. Most of my patients have cancer, but I also see patients with organ failure, neurological conditions such as motor neurone disease, and dementia.

Most, but not all, are at the end of their lives, and it is my job to help with their psychological and spiritual concerns as well as their physical health needs. People often need practical help, such as support with family, housing and employment issues, but my work can also be very creative as I help people find ways to cope.

Many of my patients will confront big issues, and reflect on how they have lived their lives. When you are in this space with someone, it can evoke lots of early attachments, so I can sometimes become like a parent or other significant relative.

I also see some very intimate and tender moments in my job. I once worked with a 19-year-old who was in the last four days of her life and wanted to marry her boyfriend, also 19. They were both mature, but they were young and vulnerable, so I counselled them about this. They went ahead and married in the hospital, where she died a few days later.

Sometimes I am asked if there is such a thing as a good death. To be honest, I am not entirely sure what this means; many people die as they lived, which can be chaotic or unpredictable.

I once worked with a war veteran who had survived a sinking ship where lots of his friends had drowned. He refused pain relief as he had made a promise when in the sea to not forget his colleagues. He told me he was going to die facing suffering as he felt guilty for having survived.

This was heart breaking for me. I visited him every day, and he was in excruciating pain. I was prepared to help him, but I also gave him the space he needed to think about his choice. The palliative care staff were wracked with guilt; we knew we could help him but we just couldn’t reach him, so we stayed with him and abided by his wishes.

Our work is very emotional, but I work with a fantastic team who care very deeply about their colleagues as well as their patients. In fact, if I needed palliative care, I would want my colleagues to deliver it.

This type of service often goes unnoticed, as do those who deliver it. To make it less of a secret service, we need to tell the public more about what we do. We go into people’s homes and deal with whatever is behind those doors. We do what is needed when people are at their most vulnerable.

Maggie-Bisset

About the author

Maggie Bisset has been a nurse for 27 years. She has worked in the palliative care field for 20 years, and has been a nurse consultant in palliative care for ten years. Originally from Fife, she is now part of the palliative care team at Central and North West London NHS Foundation Trust, which sees more than 1,500 patients a year across three sites.