Wednesday, 5 July 2017

Palliative care and the power of mind over matter

It was a pleasure to have a chat with a Palliative Care Consultant the other day.

Noble mission
A Consultant, in this context, and for those more used to American terms, is the equivalent of an Attending Physician. Or, for those not too familiar with either system, a senior hospital doctor. As for Palliative Care, its the field served by physicians who are not trying to cure, because the patient has a condition beyond the capacity of medicine to cure in its present state, so care is focused on eliminating pain and giving a patient the best possible conditions of life. 

In the circumstances.

Strangely, such care, rather like the hospices where it is often dispensed, is generally joyful. Hospices, housing dying patients, are places where the one great question has been answered. The reply – “you’re dying” – may not be the one we most want to hear, but it has been given, it is definitive and there’s no further point in tormenting oneself over it. Instead, both patients and carers can focus on making the last few months as pleasurable as possible.

“Yes,” said the Consultant who was talking to me, “but I deliver my care in this hospital. As soon as a patient moves from the curable to the non-curable category, but before they move to a hospice. And you’d be amazed at how much we can do.”

I nodded.

“There’s even good research evidence that well-delivered palliative care extends patients’ lives. I’m treating patients expected to survive ten years.”

“Perhaps the fact that they’re happy and free of pain explains their survival.”

“I’m sure it does. But isn’t it extraordinary? How does mood overcome pathology?”

“Do we perhaps underestimate the power of the mind over the body? Take the placebo effect: it can have immense impact.”

“It can,” she told me, ”placebos have been used as anaesthetics. And, you know, during the Second World War, when morphine stocks ran out, they called on it. They’d tell soldiers who’d lost limbs or had them smashed up, horrible injuries, men in agony, that new stocks of morphine had been received. And then inject them with saline. ‘Aah,’ they’d go,” and she opened her arms in the gesture of a man relieved of terrible pain, “thank God! At last.”

We really don’t take enough account of the effect the mind can have on physical suffering. It’s probably the main source of the efficacy of alternative medicine, in particular of homeopathy: it works because you believe it works. But, even if its based on belief alone, it really works.

A chastening thought for an over-materialistic age. But also a wonderful tribute to the admirable, joyous specialty of palliative medicine. I’m pleased to have met and had a conversation with one of its expert exponents, however briefly.

Hers are vital skills. Any one of us may some day call on them.

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