Is The End Of Life Patient Charter Dead Then?

I was first made aware of the launch of the End of Life Patient Charter last June via the excellent Pulse and it too was reported widely in the media – please read this article in The Guardian.

The EOL Patient Charter is a collaboration between the End of Life Care (EOLC) English Working Group of the RCGP with the RCN and the Patient Partnership Group and its aim is laudable in that it seeks to ensure that patients nearing the end of their life receive and expect an ideal of best practice  from their GP and Primary Health Care Team.

The EOL Care Charter reads as follows:

“We want to offer people who are nearing the end of their life the highest quality of care and support. We wish to help you live as well as you can, for as long as you can. Therefore, if and when you want us to, we will:

• Listen to your wishes about the remainder of your life, including your final days and hours, answer as best we can any questions that you have and provide you with the information that you feel you need.

• Help you think ahead so as to identify the choices that you may face, assist you to record your decisions and do our best to ensure that your wishes are fulfilled, wherever possible, by all those who offer you care and support.

• Talk with you and the people who are important to you about your future needs. We will do this as often as you feel the need, so that you can all understand and prepare for everything that is likely to happen.

• Endeavor to ensure clear written communication of your needs and wishes to those who offer you care and support both within and outside of our surgery hours.

• Do our utmost to ensure that your remaining days and nights are as comfortable as possible, and that you receive all the particular specialist care and emotional and spiritual support that you need.

• Do all we can to help you preserve your independence, dignity and sense of personal control throughout the course of your illness.

• Support the people who are important to you, both as you approach the end of your life and during their bereavement.

We also invite your ideas and suggestions as to how we can improve the care and support that we deliver to you, the people who are important to you and others in similar situations.”

A letter from the RCGP was forwarded to all GP practices with the intention that they and other primary health care teams would ‘sign up’, discuss with care homes (and provide supportive training), display a poster on the waiting room wall, discuss with patient groups and also patients receiving palliative care (and their relatives) and that patients and relatives should receive a copy of the Charter.

Erm, it hasn’t happened.   Search Pulse and it is impossible to find one article as none are archived.  I did watch two videos there – one in which Dr Clare Gerada stated that GPs were best placed to initiate conversation re the Charter in care homes as they ‘know the patient best.’    Mmmmh, maybe in London Dr Gerada – but certainly not in my neck of the woods!

It is possible to find stuff on GP (online) but not much and I have never seen said Charter displayed at a GP surgery – and I do visit quite a few with our residents.

On the launch of the charter Dr Gerada stated "Care seems to break down at the very end. So often a GP has looked after someone really well, and then they are not there."

The reason for this post, two of our residents have recently died with a terminal illness and I feel strongly they would have welcomed interest in their situation from their GPs – but it was not forthcoming.  Not sure they would have welcomed their own copy of the Charter though – I certainly wouldn’t as to me it (in the format offered) would be akin to receiving a ‘Well Done, You’re Dying!’ certificate…

Is the End of Life Patient Charter alive anywhere?

Anna :o]

Breakfast

Breakfast, 1921, Fernand Leger

Wind whistles,

rain taps its rhythm on window pane,

hearth fire crackles,

radiates its warming glow.

Early morning coffee-scented,

croissant smile

lipsticked strawberry jam,

me freshly squeezed in loving arms,

love being loved by you.

Anna :o]

With thanks to Tess at The Mag for the inspiration.

A Very Brief Encounter

Day breaks – sunrises!

Alarm sounds

Du-du-du du

Du-du-du du  

Du-du-du du

He wakes, unfurls, rubs eyes,

stretches body, toes curl.

Du-du-du du  

Du-du-du du (click).

Showered, shaved, ‘tache clipped. 

Toast buttered, egg cracked, toast dipped. 

Coffee drank, lips licked.

Door slammed, rushes to station,

he’s-catching-the-train,

he’s-catching-the train,

he’s-catching-the-train.

sixty-six minutes to his destination. 

Looks at his watch, train running late.

Will-he-be-late, will-he-be-late,

will-he-be-late

for-the-very-first-date?

She’ll-be-there waiting-for-him

Under-the-clock. 

Waiting-for-him, waiting-for-him. 

Tick-tock, tick-tock,

tick-tock, tick-tock.

He arrives at the station

ten minutes late at his destination.

Will she be there, waiting for him

under the clock, tick-tock-tick-tock.

He straightens his tie, lick combs his hair,

will she be there, will she be there?

 Pats posy of roses, supposes she likes roses,

 but will she be there, will she be there?

Ah there she is wearing carnation

waiting for him under the clock at the station,

tick-tock, tick-tock, tick-tock, tick-tock.

God she’s chewing gum with mouth wide open,

Smudged ruby lips and some teeth are broken!

‘Are you Hugh?’ she screeches, ‘You Hugh?

Ya late - ya late for our very first date!’

 as she reaches across for the posy of roses.

He’s starting to panic,

heart thump-thump-thump-thumps. 

My God this woman is manic

and she’s fondling my rump!

Dithering, dithering, what to do, what to do,

a man in a panic is dithering Hugh!

‘Madam’ he stutters ‘I fear you’re mistaken,

 I am not Hugh and my heart’s ‘ready taken. 

The posy of roses is for my good lady wife

who is arriving quite soon on the 6.40 from Fife!’

‘Ooooo, that’s sad that’ she utters

as she starts a-kissing

‘Stay with me for a while,

you don’t know what you’re missing!’

Heart is in overdrive,

thump, thump, thump, thump,

he prises her lips off his face,

takes her hand off his rump.

‘O Madam!’ stutters Hugh as he panics and blushes,

and tail between legs from the station he rushes,

reaches a pub orders pork-scratchings and ale

(heart’s revving down, heart’s  revv i n g   down,

thump-thump,   thump,     thump).

Silly old Hugh has been such a chump,

this lady's no lady of that he is clear

and there is a ‘Phew’ from dear Hugh as he sups at his beer.

and he makes a decision without reservation

‘No, not ever, no never ever again

will I meet a strange woman

under the clock at the station!’

Anna :o]

Entered at Open Link Night at dVerse~ Poets Pubs.  Cheers dVerse!

Image: courtesy of wikimedia commons with thanks to the author Ralf Roletschek (talk) - Fahrradtechnik auf fahrradmonteur.de

The Drawing Room



Big Room, 1948, by Andrew Wyeth



It was the Sunday room

‘cept Sunday never really came;

 one loveless day blurred into the next...

It was the drawing room,

guests entertained by perfect hosts…

Bottom nanny tapped

“Go in!  Go in,

my little precious one,

they’re waiting!” 

(Mummy what I want most of all

is to be your friend...)

…and I’d go in

hating the feigned affection,

affected for the sake of others,

held close to your chest

I’d feel your bitter cold

as you muttered

empty loving words in longing ears,

mixed messages of frigid mother love.

(Mummy what I want most is to be your friend…)

Life ends, nothing left of you

but dust and bitter memories.  

The room draws me in

and I see you there

hiding in the gloom and shadows

gazing at my photo on the mantel

and I finally understand,

how can those

who have not known love give love,

you reach out for me

from beyond the living

and I feel the warmth within your hand.

Anna :o]

With thanks to Tess at The Mag for this weeks prompt.

The Vendor





Big Issue seller, Oxford, 2006

"Please buy Beeeeg Ishooo"
he pleads

in his dirty postcard rasp

that grates,

irritates so much

that I want to slap him down. 

He grasps at unoffered hand

“Thank you, thank you lay-deee,

you buy Beeeeg Ishooo?”

Can’t he see how he makes me cringe?

Can he not understand that

“No thanks!” means No Thanks

and I know that he is homeless

and I should take a good look at me

and wonder what I am all about

as he shouts, begs, pleads

“Pleeeeze buy Beeeeg Ishooo,

pleeeeze lay-deee!”

But I can’t, I can’t.  

If only he would not beg

in that sleazy voice,

grab hold of me with greasy hands,

stare at me with that pleading face,

can he not understand

he makes my blood boil

as he knowingly invades my space,

takes away my choice of Yes or No

as he pressures for a Yes and only a Yes?

Sorry fella,

know your fighting homelessness

but from me it will always be “No thanks”
and that's just how it will always be.

Anna :o]

Today’s Meeting the Bar at dVerse~ Poets Pub is hosted by Victoria C. Slotto and the theme is ‘Writing Characters.’  Thanks Victoria!

The above is an observation of a street vendor and unfortunately it is true and perhaps it is as telling of me as it is of said street vendor?  I am ashamed of myself for having such an antagonistic opinion of this man which must come across (to him).  I really can’t help it for there is something about his manner that infuriates and I really can’t escape him as his pitch is the entrance to the bus station where I catch my bus…

For those of you outside of the UK selling The Big Issue is a means by which those who are homeless or at risk of becoming homeless can ease themselves back into the workforce by selling the magazine on a fixed pitch and earn money on each sale.

Please click onto The Big Issue Foundation to learn more of this charity whose mission is: “The Big Issue Foundation is a national charity which connects vendors with the vital support and solutions that enable them to rebuild their lives and journey away from homelessness.”  

Image: courtesy of Wikimedia Commons and the author is Kamyar Adi.  Thanks Kamyar!

(Please note that the vendor in the photograph is not the man that gets on my nerves!)

PS Don't know what happened above (to first two lines) - tried to respace but the blog seems to have a mind of its own...

Strange Comfort

There is a sad strange comfort here

Drowning sorrows in sweet red wine.

We raise our glass and feign good cheer,

Sad little ladies of the vine.

Sad little stories intertwine

As secret longings we confess,

Our secret pain we do consign,

Drinking to drown our loneliness.

Anna :o]

Hah, an end to writers block, thanks to Gemma Wiseman at dVerse~Poets Pub!  Today is Form for All and the form is that of the Huitain.  Gemma writes:

There are those who claim that the huitain is French in origin, and others who are adamant it has Spanish origins. Either way, it was popular in the 15th and early 16th centuries and was often used for epigrams in the 18^th century.  The form evolves around the number eight.

In France, the huitain was closely associated with the ballade which comprised three eight line stanzas, with the last line being a refrain. The ballade was set to music during the 13^th-15^th centuries.  But the huitain dismissed the refrain element and the music.

The original huitain is a single verse, eight line poem with eight syllables per line. The rhyme scheme is:
a
b
a
b
b
c
b
c

Cheers Gemma and also to the wise man who unknowingly was the inspiration for the words of this poem.

Image: courtesy of Wikimedia Creative Commons Red Wine Glass by André Karwath aka Aka

Depression

Image by Zelko Nedic

You watch me
through those damn dewy eyes
that torment my soul
and steal
the very heart of me.

The warning growl
through snarling teeth;
the putrid breath
feeding despair
and souring hope.


You are my black dog,
forever vigilant.
there is no escape.

Damn your dewy eyes.

Anna :o]

Tess’s excellent prompt at The Mag brought to mind the above I had posted earlier last year and it really didn’t get much of an airing.

I was tentatively dipping my toes in the poetry world then only having entered Magpie Tales twice prior to posting Depression on its little lonesome, linked to nothing but my desire to write.

Depression appeared a natural response to the prompt and I have therefore posted again.

*********************************************************************
Hello again!  I have added this bit today (30.07.12) in case some folk are unaware that ‘The Black Dog’ is a metaphor for depression.   I think most of us attribute the term to Winston Churchill although it is possible it was conceived prior to this.

I should make you aware that I do not suffer from depression, in fact I am rather happy-go-lucky in my approach to life – but that doesn’t mean I don’t care about anything for I surely do.

I work in mental health and I listen to the people I care for - and learn, for to (pretend) to care without understanding is not caring at all.

Here is a link to a Black Dog article at PsychCentral – just here!

The Old Asylum




Corridor. Hellingly Asylum, Sussex by James C Farmer

 



Figure Eight, 1952, by Franz Kline



Seed, parachuted,

drifts aimlessly on passing breeze,

upon a lull descends

amidst the grass and tangled weeds

that strew the paths,

choke the very heart

of the Old Asylum grounds.

Time stands still,

the clock unwound upon its tower

hides amongst the chestnut trees,

and some way below,

the door, chained,

keeps its secrets locked inside,

defiant, repels (for now)

Ivy’s attempt to stranglehold, invade,

as she tries to squeeze her tendrils

through decaying slats and shatter glass.             

Elsewhere

corridors echo eerily the slightest sound,

paint peeling curls upon the walls,

leaves its angry scars

as it flutters wearily to the ground

to join dust and dirt and debris

dropped from gaping ceiling.

Life stirs,

bristles in the old abandoned ward,

spiders spin fine thread from spinneret,

a window chink lets in solar rays,

lights up swirling silver dust heaven bound

and bedsteads rust upon the ground

as fly struggles in spiders sticky web

and in the roof space

wasps nest nestled in the eaves emits a buzzing sound

as pigeons coo and play

perched high upon the rotting rafters.

Seed, parachuted,

drifts aimlessly on passing breeze,

bees dip thirsty tongues in flower hearts

sing gratitude with pleasant hum,

wood pigeon cooo-coo-cu in chestnut trees

as nature breathes its love of life,

takes refuge in
the Old Asylum.

Anna :o]

Tess’s prompt at The Mag was that of the Figure Eight and spiders eight legs immediately popped into my mind.  Prior to the prompt I had been taking a trip down memory lane, viewing abandoned asylums on Flickr and had come across the hospital where I did my training and the resulting poem was a combination of the two.

The poem is also entered at Open Link Night, hosted by Joseph Hesch at dVerse~Poets Pub.  Thanks Joe!

ATTENTION!  ATTENTION!

Totally remote from the above please view this YouTube video “Som Sabadell flashmob.”  Wonderful!  (As no-one has mentioned this I have highlighted it!   Please, please, please view it - it moves me to tears every time I do.)

Image; courtesy of James C Farmer at flickr photostream.  (I did not do my training here!)

Letting Go



Bedruthan sunset by Ennor



Like a fish

out of water,

you lie there,

delicately gasping,

mouth shaping

to catch
elusive breaths,

and once caught,

as if some knowing

afterthought,

you let them go.

Sing me your death song.

Little lady                

you have left me now.

Mortal coil surrendered,

demons vanquished,

soul ascended,

serene and silent,

life complete.

Anna :o]

Although a ‘little lady’ is mentioned I wrote this several months ago when I thought of Joe.    Joe was a resident in a home where I worked in the nineties. 

Joe was in his eightieth year and had been transferred to the home when mental health services became ‘Care in the Community’ resulting in the closure of the psychiatric hospital where he had spent over fifty years of his life.

Joe had schizophrenia and his was an ‘expected’ death as he too suffered from a terminal physical illness.   Joe was aware he was dying; his voices (auditory hallucinations) knew too and continued to taunt him mercilessly during the last hours of his life. 

If there is a God out there he cruelly played with Joe to the bitter end…

I have never forgotten Joe.

Linked to the good folk at dVerse~Poets Pub (thanks tashtoo) and The Poetry Pantry (thanks Mary) at Poets United.

Image: Courtesy of Ennor at Flickr.  Thanks Ennor

Sleep of Death



Ophelia by Odilon Redon



Oh my lord was thy affection

nought but a cruel ruse,

a cruel play upon this maiden,

was my love but to amuse? 

Oh my heart is heavy laden,

yearning for the want of you.

Oh willow will cast off my wanting,

still the melodies of my breath,

lay me in the muddy water,

send me to the sleep of death,

there I shall dream forever,

forever dream my dreams of you.

Anna :o]

With thanks to Tess at The Mag for the inspiration.

Earth Man: Genesis



Still Life, 1670, detail by
Jean Francoisde La Motte



Willow weeps her tears of sadness,

they bitter with the pain of parting

burn hot and deep driving her to lonely madness,

course, rage through her very vessels,

sear and burn her broken heart.

In yonder forest he earth emerges,

flesh made of mud,

cold heart rough hewn from stones,

precipitation is his lifeblood,

twigs and branches make up his bones.

Willow cannot cope with his rejection

and deeply wrought in her dejection

rips out his letter affixed to door by nail and band

and reads the words of her amour.

His heart is made of stone,

yet devoid of all emotion

he does not wish to be alone,

will seek out the lonely in their shadows,

needs to make their beating heart his own.

She reads his words in lonely anguish,

tears splash down and blur, stain his missive,

she yearns for his love, his smile, his kiss, if

only he would return again…

Trembled the stars

that devilish night the earth man sought her,

(he would steal her heart as he slyly court her);

fashioning his face to that of her amour,

he gently taps upon her door.

She sees him, heart dances to her head,

his lips brush hers (she tastes the strangeness)

as he lifts her up, takes her to her bed. 

(Uncertain of his new persona

she mentions not the change less

he again should leave her…)

Noticing her reserve he does deceive her,

bluffs his way into her heart,

says that his leaving let him grieving

and he knows they now should never part.

Her flesh did crawl as she let him love her

as in her heart she knew he was another –

but ‘twas too late as he now did own her…

Stepping into the night

lit bright by moon and its corona,

stars trembled as she walked cold beside him,

knowing that her heart did beat inside him,

fate sealed in that first earthy kiss,

evolving earth man genesis…

Anna :o]

With thanks to Tess at The Mag for the inspiration and also brenda w at The Sunday Whirl (wordle 60) for her inspiration too!

Old Age Cometh

Old Man, Cockroach
Catcher

It has come.

It has played with me,

led me to believe,

nay be certain

(that maybe through

some past good deed)

I had escaped its wrath.

It has come. 

Mapped me out,

history etched

in every line and furrow. 

It plays with me

still,

slows me down,

mocks me

with its laughter lines.

It has come. 

I will bear its tired skin,

its aching limbs,

its tired bones. 

I will relent,

give in graciously,

but beg it earnestly,

please, please, please,

please

leave my mind alone.

Anna :o]

(I wrote this after discovering the beginnings of crows feet on Saturday night...)

Entered at Open Link Night at dVerse Poets Pub – thanks dVerse!
Entered at The Poetry Pantry at Poets United - thanks Poets United

Image used with the kind permission of the Cockroach Catcher at flickr.  (The Cockroach Catcher Blog can be found here.)