Quality of hospice care

Some 20 years ago I spent two weeks attending a course on hospice care at St Joseph's Hospice, run by Irish Catholic nuns in London's East End.

Recent remarks on the so-called 'concept' of terminal care prompted me to look up what I wrote in my diary at the time. I quote: "To spend time on the wards at St Joseph's is a worthwhile experience. The all-out palliative care of very ill patients combined with the abdication of the curative approach left me mixed up at times.

"Having spent so much of my life-work going all out to prolong life in the very ill patient with cancer I realise that hospice treatment at its highest level has a quality which is quite different from the usual hospital way as I have practised it. I still felt intensely interested in the precise stage of the disease, in the exact pathology and the detailed medical history of the patient. One of the last patients I saw was a Mr J.P. a 79-year-old Jewish musician from the East End. He brought his cello with him.

"He had a widespread recurrence of a gluteal carcinoma and was having difficulty and pain passing urine, often passing blood clots. His face was sharp, high coloured and alert. His hands were intensely cyanotic as were his feet. His lower limbs were swollen with pitting oedema.

"This was an unusual case but the clinician in charge did not express any special interest in the natural history and dynamics of this man's disease process. He, rightly no doubt, was intent on relieving the patient of his distress and affording him every comfort.

"The goodness and brightness of the nursing religious Sisters shone through the inevitable desolation of the outcome."

I have ever since believed that Malta, with its tradition of holding dear its Catholic religious institutions, would ideally have a hospice run by a religious order to care for people suffering from terminal cancer. It is an answer to the occasional cry for euthanasia.