Hannah Haberland accompanies people who suffer from an incurable disease, in their last days and weeks. FOCUS Online gives you an insight into their work and reported to a tumor patient who has stayed beyond his death in memory.
The woman sitting across from me, I would call under normal circumstances, as a very attractive Mittvierzigerin. With her long chestnut brown hair, she looks very girly and the way she sits with wrapped legs on the Couch, still strengthens this impression. However, these are not normal circumstances. Unfortunately.
“Mrs Krause*…” I search for the right words. “We have to assume that her husband developed an increasing intracranial pressure. He has vomited several times already gushing, is really responsive and extremely restless.“ Mrs. Holmes immediately begins to cry.
About the guest author
Hannah Haberland was born in 1984 in Northern Germany. After her medical studies she did a residency in anesthesia and then the additional designation of palliative medicine. Since some years she works in a Team of Specialized Outpatient palliative care and care in a multi-disciplinary Team for people with incurable diseases until the end of her life.
I hand her a handkerchief. For the umpteenth time, I am angry that I am to this conversation, alone and not one of our Specialist nurses have taken. Then would not now be all the weight on my shoulders. A quick glance at the clock. It is half past two. When, said Ms. Krause again, the children come out of school?
I met Mr Krause for the first Time two weeks ago
My thoughts go back to my first encounter with Mr. Krause two weeks ago. Since he had already done a pitiful sight. The Tumor in his stomach had spread to the bone and now also in the brain. He had to repress successfully managed, one must perhaps also, if it is just the end of fifty and two school-age children.
On our first visit, he was able to keep on the legs. A successful businessman, Machertyp, but not unsympathetic. His doctor had advised him to seek a Team of Specialized Outpatient palliative care, short-SAPV, as the pain in the bones and the pressure of the metastases to the spine had increased so far that the house doctor with the extent of further therapy felt overwhelmed.
I could understand that only too well, for such cases, we are here for. We are a Team of Doctors and specialized nurses, and our task is to accompany people who suffer from an incurable disease in the terminal stage, in their last days and weeks, and to alleviate the suffering.
The last time, enjoy
“You don’t know how it is… to die…”, Mr said Krause during our first encounter and the pain at the back focus point. “Not from my own experience, no,” I answered. Mr Krause looked at first puzzled and then had to laugh. “Yes, that would probably also requires something much more. But you have to tell me. I don’t want to lie here and me in front of the pain curve. I just want to enjoy the last time with my family. Somehow. Can you fix it?“
I looked at him for a Moment and took a deep breath. “I can’t promise you that you will be at any time free of pain. But I promise you that you will not have to suffer and that we are always here for you.“
Two weeks a good quality of life
I clear my throat and put my next words carefully, my Hand on the woman’s Frizzy shoulder. She allows it. “You know, I promised your husband that he does not have to suffer?” She nods hesitantly. “But he does not have it yet. Isn’t he getting all this?“
“We can’t assume that unfortunately. This unrest, which, he shows, is very distressing. It is as if you had the whole day the feeling that something is looking, and you know neither what you are nor where it is. And this vomiting is also not something you want him to continue to push.“
In thought I would add that he probably also still have a splitting headache, but this Information Ms. Krause is not really need now. After our first visit, we had to get through an adjustment of the medications and by Adding a needed medication, the pain situation in the case of Mr. Krause really good in hand and he had again had two weeks with a good quality of life, in which he time with his wife and children could spend.
SAPV – helpers in the last weeks of life
It especially cancer patients, who want to spend their last time at home and often can. In order to do for the sick and their family members, there since 2007, specialized outpatient palliative care (SAPV). Doctors, nurses, social workers, or psychologists with a “Palliative Care”-additional training, make home visits as needed and according to the needs of the patient. The SAPV-employees that primarily serve patients suffering from complex symptoms (pain, shortness of breath, panic…). Also unsettled members be advised, reassured, and often comforted, It’s a 24-hours-on-call. The SAPV-stations are organized on a regional level. The physician can prescribe their use by prescription.
Information about the local SAPV house doctors, clinics, and health insurance, General information, of the German society for palliative medicine and the German hospice – and Palliative Association.
Now he has two days tops to live
In the last night the Situation was flipped but. Mr. Krause has now just some hours to live, at best one to two days. “What do you suggest?” Mrs. Holmes looks at me anxiously. “Well, he can’t swallow his medication. We could attach a drug pump, so he gets to continue to painkillers, something for Nausea and vomiting, and a sedative, so that this agitation subsides,“ I say.
Now Ms. Krause nods. The drug pump we had ever spoken. “Okay.” She looks blankly past me out the window. I feel kind of guilty, which of course is nonsense. Mr Krause is going to inherit soon pass no matter what I’m doing now. I can only stick to my promise, and his symptoms do not alleviate, that he torments in the last few hours.
I syringe Mr Krause careful some drugs, and waiting, until his face relaxed and his breathing is calmer. Then I hang the drug pump and explain it to his wife. I’ll go first, as I’m sure he’s sound asleep.
Mr Krause dies the next Morning. His wife is with him and holds his Hand. He looks quite peaceful. Everything is as he wished it.
*Name of the author changed. Hannah Haberland has anonymized all the cases in your book, in order to safeguard the identity of patients and their families. In it she refers to other cases, and there are touching insights into their daily work: