Silversea Water Cooler: Welcome! Part Four

[Daveywavey70]

I can’t imagine how difficult it must be in the situation JP. My friend received the absolute best care in our local hospital. Upon being transferred to the hospice, I was there when the doctor came to see her shortly after admission. She clearly told the doctor that she had no pain when asked. He never the less decided to start administering a combination of the 4 drugs prescribed through the driver. Like I said within 24 hrs she was unconscious and within 48 hrs she was gone. Every person that I have talked about this with who has had loved ones in this hospice has had a similar experience. I Have no ethical problem myself with the concept of using life ending medication in the right circumstances and with the full understanding of the patient and or their loved ones, but I was extremely uncomfortable about the way my friends and others cases had been handled as a matter of routine in this particular hospice that has both a very high demand for bads and a very quick turnaround. Had it not been for the risk of hurting her husband who is very frail, I would have asked many more questions than I did.

[57 varieties]

Well put JP. Thank you for taking the time to explain a very difficult set of decisions from a medic’s point of view.

 

 

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[UKCruiseJeff]

Good Morning All,

 

What a difficult subject. It is a shame that there hasn't been more open discussion about this issue and that there seems to be a conclusion in the UK at least that these decisions seem to be taken without candid consultation and informed consent from the people close to the patient. If the UK people were aware that some hospice work more like "killing farms" however well the intentioned is their motives is stated to be, then we could start to have the adult debate.

 

Thanks JP for explaining how difficult these situations are.

[mysty]

Greetings Coolers!

 

JP...thank you so very much for taking the time to explain the situation from a medical professional's point of view. The whole situation of how to humanely deal with patients at the end of life is tricky in many ways. I watched both parents slowly die from cancer many, many years ago. They were well-cared for and had access to pain relief that worked well for them. It was much more difficult for the family. And having to have difficult conversations with the patient and family members would be a task that would require Herculean emotional effort. Palliative care is a wonderful option when it is available. With over-crowded hospitals, shortages of staff due to budget constraints and not enough Palliative care beds....not enough people have access to the "softer" death. I think it was the apparent dishonesty and the lack of investigation into the deaths in the UK that I had the most difficulty with.

 

To lighten the mood here is today's funny.......thankfully I have never had to resort to any threat of physical violence in Myster's case! :)

 

 

Have a great day all!

[jpalbny]

The other variable to be considered is time. You cannot have this conversation during a 15 minute healthcare visit with your primary care doctor (GP, for those of you on the other side of the Pond).

 

There is a huge push over on this side to have these conversations with your PC/GP before anything happens but the reality is that no health care system will pay for the necessary time in order to make that happen. To use an example from my work, nobody will allow 30 minute appointments on our primary care clinic in order to provide both the necessary medical care, and allow sufficient time to discuss these issues. So obviously these issues get pushed to the back burner. I have time in the ICU because (1) it's critical, because a decision HAS to be made then and there, and (2) I am not on as tight of a schedule.

 

Is it similar in the UK, where the staff in these hospices are overscheduled, overextended, and don't have enough time to have these conversations the right way? Do you have time in your regular GP visit to have these conversations? Certainly not excusing uninformed euthanasia, which is morally repugnant, but wondering about the root causes.

[UKCruiseJeff]

Lovely funny M!

 

Hi JP,

 

Most if not all GP surgeries work as independent businesses in the UK and have their own processes and procedures. In my own for example some appointments are 5 minutes but regular ones are 10 minutes. You can call in and request a double appointment but it is likely to be some time in the future and may or may not be with the doctor who "knows you". On my last 10 minute appointment however when we discussed medication withdrawal/reduction based on my "informed" decision making he was extremely good and the appointment ran over to be around 30 minutes. Wifey came with me to ensure we all understood what I'd agreed.

 

On the other more mundane topic of Whispergate I spent the weekend writing the detail of the experience to Silversea of our "ultra-luxury elegant and relaxing cruise with a delightfully convivial atmosphere with casual sophistication with like minded guests" or as they say “The Gold Standard by which others should be judged” and I guess we will see. :(

 

A few minutes after sending it I received an SS mailer with the title "Relax. Renew. Rewind. Slow Down.":(

[MLeh]

JP: As always, I am in awe of your writing abilities. Thank you for taking the time to share your intimate knowledge of the medical profession with us.

 

We've been going through the 'discussing the end of life' scenario with my parents, who are both medically challenged, as well as dealing the recent (unexpected) death of my brother-in-law from cancer. Health care is challenging!

 

We are fortunate that my parent's primary care physician knows them both well and always takes the time to explore the nuances of their care with them and other concerned family members. My mother, in her 90s, is sound of mind, but has many physical challenges. Dad, approaching 90, suffered a stroke a couple of years ago, so although relatively healthy (for his age), suffers from depression and other mental issues directly related to the stroke and his knowledge that his brain function is not what it used to be. The last couple of years have been a huge challenge, and after a horrible beginning to this year we're finally at a very fragile 'balance' right now with twice-daily in-home care. Not looking forward to the next step.

 

Jeff: the saga continues, does it? As math geek, I'm curious about the ramifications of 'a 20% discount on this cruise equates to only 8% discount on our future booked cruise'. Did you get a really good deal on that most recent cruise? (Makes one remember the adage "if it seems too good to be true, it probably is.") The other option is that your next cruise is a much longer cruise versus the 7 days of your most recent. Like I said: Math Geek, and just curious how the math works.

 

Mysty: always enjoy your funnies.

[UKCruiseJeff]

Good afternoon all ...

 

A Bayonne ham panini with tomato ... and so far around a stone down!

 

 

 

 

 

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[mysty]

Congrats J!!!! And the panini looks scrumptious!

[UKCruiseJeff]

Thanks M,

 

I have cunningly worked out that my Torp gives me roughly 70 calories per small glass of Gosser. I convince myself that I only need a sip! :D

[mysty]

It seems that mind over matter is definitely working for you J! I wish I could train my mind to do the same. Currently it seems that my mind has a "mind of its own". :(

[MissSophia]

Hi Coolers.....

 

Interesting discussions going on....sorry for DW having to see his friend in the hospice.

I sadly have seen these happenings too often going way back twenty three years when l lost my mother and also since.

I was once told that all Hospices have just a fourteen day window despite what one is told.....having said that l do appreciate comments from JP being on the other side....it’s very difficult.

As l get older l disbelieve what one is told by the medics....GP’s today are under so much pressure to deliver...that’s if one can get a decent appointment with one’s chosen Dr...l therefore only attend my surgery when summoned for the bi annual mot check....and then lie through my teeth about my lifestyle by just telling them what they need and indeed want to know.....when my number is up l shall just retire gracefully knowing I’ve done it ‘My Way’......without all the bother for both myself and my kids.....

 

Today it’s six years to the day when my darling hubby left this world of his own choice...very hard to deal with still when so many folk don’t have a choice....

 

On a lighter note...life is to be enjoyed and I’m currently enjoying spending time with my oppo mother in law who’s up from Hampshire staying with our kids....it’s so much fun getting into mischief behind their backs...and also so lovely seeing them having to conform....🙈

 

Just have to add a comment about the Jane McDonald thread on the ‘official’ boards which l have no desire to become involved with...’officially’.....

Isn’t it just great to slate and slag such a lovely lady off without really knowing the true facts about her....bearing in mind that as usual folk know that she can’t defend herself on a public forum.....a bit like the SS Hotel Directors that have in the past been named and shamed......and on that note...l best shut up!

 

S😊

[Bill B]

The other variable to be considered is time ... To use an example from my work, nobody will allow 30 minute appointments on our primary care clinic in order to provide both the necessary medical care, and allow sufficient time to discuss these issues.

 

Rhetorical questions:

 

Who is "nobody" and why do you, as the physician, allow them to dictate your schedule?

 

Why is there never enough time to do something properly the first time, but always enough time to do it twice?

[Lois R]

Davey, so sorry about your friend and it does sound like a terrible experience:(

 

I know ya'll had mentioned Hospice...….my mom died in a Hospice back in 1993 and it was the first time I had experienced that type of care first hand. I give BIG Kudos to the nurses...…..they are simply fantastic. I remember hearing the term "Death With Dignity"...…...it is a very true statement.

 

Hey Mysty, just want to let you your pictures always make me smile:) and I have needed them lately.

And Jeff, still loving your food photos too.

[drron29]

Having practiced medicine for 48 years-Yes I know hopefully I will get it right soon-I have been faced by this situation many times.A driver will not be started until I personally have talked to the patient and their family.It is always explained that this will shorten life but should make it much more comfortable.I do usually have my registrar and intern along because at times the information hasn't been taken in or a question hadn't been asked.

What you describe Davey is not the way to do it.

[mysty]

Greetings Coolers!

 

Thanks drron for adding more input from a medical professional's perspective.

 

Today's funny.....

 

 

 

Have a great day all!

[jillyf]

Musty, your funnies make me smile, and often laugh out loud.

 

I retired 15 years ago, but have been the Unit Manager of a Palliative Care Unit in Melbourne. I set it up with my clinical partner a Professor of Palliative Care. It was a wonderful experience, but very stressful getting the funding from the Government.

Before I got that job I worked in community Palliative Care and also in a hospice.

Being the manager of a new unit gave me the chance to put my ideas into practice and employ the staff I wanted. I loved the work and believe our unit was a compassionate, caring but very professional place.

I would have been appalled to have such a terrible thing happen as to DW and it makes me feel dreadful now that it happened and still might.

I know in our unit there was time to discuss pain control and how it would be managed. We weren’t always perfect but we cared.

I ended my career as a nurse consultant in one of the major hospitals.

 

Now I am on the board of a hospice foundation and delighted to be helping fund GP's and nurses to further their education in Palliative Care.

I am sorry that some people feel that Palliative Care and hospice are "killing factories" but i hope they can see that most places are not like that.

[UKCruiseJeff]

Jilly,

 

The start point of the discussion in this thread was the report about a regime in a Gosport hospice where it seems that at least 650 people’s lives were shortened through inappropriate care. My description wasn’t about all hospice but just about the ethos described in that one and those like it.

 

This is a typical report..

 

The Gosport scandal makes an appalling NHS 70th birthday present. The damage done will ricochet around the health service and could threaten more harm to patients, if the wrong lessons are learned.

 

Callous “life shortening” that killed at least 456 people has all the hall-marks of routine extermination of the inconvenient. With NHS beds brimful of aged nuisances, here is the spectre of overworked, desensitised staff tempted to speed the end without consent of patient or next of kin. The tenacious Gosport relatives who soldiered on despite rejection from every tier of officialdom finally – three decades later – exposed the scandal. A full 29% of patients who died of a lethal morphine overdose in Daedalus ward – nicknamed “dead loss” – were suffering no pain. Some only came for a short rehabilitation, but got sudden death instead.

 

[mysty]

Jill....so glad you are enjoying the funnies! Thanks for adding your experience to the discussion! What you have described sounds like a wonderful approach from a very caring set of individuals! Those efforts should be applauded!

[Daveywavey70]

Good afternoon all from an obscenely hot and sunny Wales. Thank you to all of the professionals that have posted your views about end of life care. It's a part of the job that I can't imagine doing and take my hat off to you all.

 

On another note, I've just come across something very interesting. Whilst preparing my file for my Solicitor, I was searching out my call logs to Silversea from my phone bill. I Really hadn't realized that when you call them on their 0844 number on their website, they are actually charging you at the rate of over £6.80 per hour. A 31 minute 15 second call, which was the longest I made to them, cost me £3.543. I Was under the distinct impression that all premium rate call charges should be made clear and it was a big No No for a helpline for a product or service you have already purchased to charge a premium.

 

Do our international friends get charged premium rates or do they provide freephone numbers in other countries?

[UKCruiseJeff]

Good afternoon Dave,

 

Irrespective of all that, it is simply wierd that Silversea think it right to use a premium rate call line to simply make contact with them.

 

Obviously “all-inclusive” doesn’t include simply talking to them. That is an “extra”.

[UKCruiseJeff]

 

 

 

 

 

 

 

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[Daveywavey70]

Good afternoon Dave,

 

Irrespective of all that, it is simply wierd that Silversea think it right to use a premium rate call line to simply make contact with them.

 

Obviously “all-inclusive” doesn’t include simply talking to them. That is an “extra”.

:)

Good afternoon Jeff,

To say I was a little surprised to see those charges would be a fair comment.

[mysty]

J...that deconstructed lunch looks awesome!

 

DW.....does SS not offer a toll-free number in the UK? Seems very strange! I think the US number is toll-free.

[Daveywavey70]

Lovely lunch Jeff, hope the sun is shining on you while you enjoy it!

Good morning M,

I Always think of Judi Dench when I say that!

No that’s the only UK number anywhere on the SS website and no warnings anywhere about what they charge you above your usual call rate. I’m sure that it’s illegal not to do so here in the UK.

 

 

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