Portraits of Russia: Anna, former Hospice Employee

Children's doctor Anna has been helping seriously ill children and adults for many years. She told Publicpost about what the dying people want, and how to make their death worthy.

About the hospice

Before I came to the hospice, I did not face death at all. There were no doctors in the family, no one was dying. But I really liked this work, it is a feeling that you are in the right place, that there is real life there. I formulated for myself, and then I realized that everyone had it. You find yourself among people who suffer not because someone is to blame, not because of violence. Suffering removes masks, pretense, and ambition. And there are people who simply hurt or just hurt. And you put it on a clean bed, washed, treated the faults, gave a sufficient fraction of an anesthetic, and fed. And he sleeps from the fact that he finally ceased to hurt. The hospice is a place where you can do a lot in life and then you can evaluate the result. It is important to discuss patients after death by the whole team - what they did right and what is wrong. This is not therapy for us, it is a working one, although there is, of course, the therapeutic effect. The result of the work, although many disagree with me is a good death. If we were anesthetized for a long, long time, and then the end was terrible, then we did a bad job. And the relatives will have this moment in memory. You need to be able to prepare everything in such a way that death comes as they wanted.

About how I got into the hospice

At the moment when I was sharply lacking humanity in medicine, I met Vera Vasilievna Millionshchikova, the founder of the first Moscow hospice. The medical institute oppressed me with cynicism, by the fact that everything is so far from caring for a person. But it was important for me to be not only about physical. The Department of Bioetics invited Vera Vasilievna, I crept into a lecture for older students and almost immediately realized that I would go to work for her. She talked about the hospice as an alternative to euthanasia, about the quality of life, about the help of the dying. She told how the hospice works, about love for this work. I don’t remember the details so well, but it became clear that this is my person ...

About colleagues

Someone can work in a hospice, but someone does not. Vera Vasilievna always took not just for a trial period, but by a volunteer for two months. There is nothing to worry about that you could not. They say that only believers can work here, but rather, a set of properties of temperament and character is needed. There are people from whom you do not expect, and they found their place in the hospice. One girl worked as a stripper - dancing, and then went on duty with a nurse. Then the striptease abandoned, gave birth to twins. And the chief physician of the Hospice recently gave birth to a third child and not a day, it seems, did not sit on maternity leave.

About how close death changes people

I am not a supporter of the theory that people are changing in the face of death. But "realness" comes out, real people come out. Disappointed, sometimes very evil - for life, fate, relatives. There was one patient who had a tumor in the nasopharynx, I often remember it. I was not a doctor then and poorly versed in the details of specific diagnoses. The tumor apparently metastasized. In the bone, at the base of the skull. His eyes were festering, the tumor grew into his mouth, he barely breathed, could not drink, eat. The young was still, about 40 years old. The wife came and said that he had been quiet, flexible, family, meek, his voice had never raised his whole life all his life. And then he became aggressive, irritable, kicked everyone out of the ward, refused to see his wife, children, and did not let the medical staff. I just wanted it to end quickly, and refused drugs. Everyone passed the ward, shook their hands. At each morning conference they said: "Vera Vasilievna, we could not, he did not let it go." So far, she did not say at some kind of bypass: "None of us know what is actually better for him. We did everything we could. If he wants so, it will be so. Our help is to give him this room. Let's respect this choice." This was struck by me in Million -Minor - respect for the human choice, whatever it may be. So he left, in the hospice.

About adults

People really want to be heard. Talk about life that have come true or unfulfilled plans. I sometimes had to hang in the ward for the whole night. Often there is a need to complete something, the need to be in time. Birth of grandchildren, weddings, dates. People ask to be clean and beautiful to come to them. They usually regret what they did not have time, but not professionally, but about what is connected with close people lost by time. What did not help their relatives enough, they were not enough invested in the children. After all, we have such a life - we protect ourselves from relationships.

About children

Working with children is different. When you communicate with your child, this always happens through the prism of whether he understands or not, what happens. But I believe that you need to try to tell the truth, although not at any age children understand what death is in principle. They understand that they are bad, that it will not be better, that mom cries because they will soon part. And the only terrible death for a three -year -old child is parting. When an adult is sick, his whole life begins to pass in this context. And in a child, the disease is one of the components of the parts. He continues to grow, develop, even when he will die soon. Children always want to study, it is laid in them. And I did not have to notice their desire to complete something, put an end. On the contrary, they have dreams, the desire to have time to make, see, find out. More children really want to help parents, protect them, ask the doctors to take care of their mother.

About the "team of pain"

I am doing now and will continue to engage in palliative help to children. But besides children's hospice, which interest is now in, I like another model. This is a team of palliative assistance in children's multidisciplinary hospitals - a doctor, a nurse, a psychologist, volunteers who work without departments, like consultants. They advise children and parents, anesthetize, work at home, prepare for death. It is very difficult to do this in Russia organizationally, but there are progressive doctors who know that hospitals in the West have such commands. For example, in London I know one hospital, where there are two teams - pain and palliative care. There, the pain is generally considered a separate problem: how to make sure that it is not painful to do even the simplest manipulations?

About whether it is possible to plan death

The second, which is even more wild for Russian consciousness is planning death in incurable diseases. There is an understanding with oncology that if a person leaves, then he needs to be left alone, do not save him. With other diseases, everything is not so simple. Each critical episode, a deterioration in the state is reversible. And cannot be said whether it is the last or not the last. Our attitude is that you must try to reanimate, and there it will go. Children are always, if they are in the hospital, die in intensive care, during an attempt to save their lives. And this is physically very unpleasant, it is a thing that morally humiliates human dignity. Most people will say that they would like to die calmly, far from doctors, surrounded by loved ones, and not with a pipe in the mouth tied to the bed. Plus, in Russia, loved ones are not allowed into intensive care. But in the early stages of the disease, you can talk with your family about what will happen next, about worsening for deterioration. So far, we will not feel that after some deterioration we hardly returned. And next time, perhaps, let's decide to abandon intensive intervention, to go not to intensive care, but to the hospice or home. But the legislation does not take into account such moments, and until it will comfortably die at home in Russia, many generations will change.