Dr Debbie Stevens is our Medical Director and a leading Consultant in specialist Palliative care medicine. This is her story….
I always wanted to be a Doctor. My Father worked in television and theatre so we moved a lot and I ended up doing ‘A’ levels that really weren’t helpful. History, Geography and Russian aren’t really what you need if you’re going to go to medical school! So I did what you could do then, a pre-med year before completing my medical degree at St Bartholomew’s Hospital in London. While I was there I met my husband, Neil. We had come to Cornwall as part of our training and then we had job offers so came back. I worked my way up through the hospital and was a Registrar in General Medicine at the Oncology Department for a long time. I also worked in the Haematology Departments. Neil was a GP in Marazion and an opportunity came up for a part time Doctor at St Julia’s Hospice and so I arrived here in 1993.
Palliative medicine didn’t exist when I was a student. It’s a relatively new speciality, so I went in to this field as it was developing and I’ve grown with it.
If I take you through what I’ve done in this week in which I am writing, it will demonstrate a typical workload and illustrate our wide range of responsibilities.
We’re ultimately responsible for the people who are in the beds at the two hospices. They are the patients for whom we have sole responsibility. We’re providing them with 24-hour medical cover, seven days a week. We have an on call rota and there is always a Consultant and another Doctor on call and we will admit people to the beds at any time, day or night. Thirty percent of our admissions come out of hours.
I was on call last weekend and was in the hospices on both days and taking phone calls as we also operate a 24-hour advice line for healthcare professionals.
We’re acknowledging that we are specialists in symptom control and though we can’t look after everybody directly ourselves, we have a very important role in supporting others. Through this line we give advice to the acute hospital, to the community nurses, to GPs, community hospitals and nursing homes.
On Monday morning I do a round of all the patients at St Julia’s Hospice where I’m based, with the Doctor who’s also on duty in the unit. We also train people who are going to be GPs so I will have one of them with me too and any medical students who are with us as they come to our charity for experience.
On Monday afternoon I attend a pain clinic. We’re very lucky in Cornwall because over twenty years ago, I joined forces with the Pain Consultant who was in post at that time, to develop an integrated pain service. Although most pains that people develop can be looked after, there is a small percentage of people who have very difficult pain and they tend to be those who get admitted to the hospices at some stage or another. The clinic is held at Treliske and its run jointly by two Consultants, one is an anaesthetist and the other is in Palliative care (that’s me), so it’s labour intensive and it’s very specialised. We are there solely to help find ways of easing the pain for those who attend.
We have a very small group of patients whose pain is so miserable that we actually put a very thin tube in to the fluid around their spinal cord so that we can infuse drugs. We’re one of the few areas in the country that do this if it’s needed. The beauty of the system in Cornwall is that we aim to get these people home.
On Tuesdays there’s an oncology clinic so one of us goes in to Treliske and joins with the Oncologists in the Sunrise Centre, seeing patients who have a malignancy that we can’t cure but who we are actively caring for. We provide them with symptom control and will continue to do this at home or in the hospice, even if they are too unwell to go to the Oncology unit.
I’ve also been to see a lady in a nursing home as we are working with mental health services to provide Palliative care for patients with dementia. It’s an area that’s grown over the last four or five years and we work hard with the nursing staff to offer care at the difficult end-stage of the illness because it wouldn’t be safe to move some patients from the secure units they are in. Moving dementia patients from the surroundings they are comfortable in can be one of the worse things you can do, so we work on an integrated approach.
We can provide them with the level of symptom control and support they would get if they were in the hospice and they can be looked by the staff who know them well.
We also see people in their own homes. We’re moving to see people where they are, rather than expecting them to come to us. In fact we look after far more people outside the units, than in the two hospices. The people who come in are the ones who most need specialist intervention so I see the beds at the hospices as intensive care beds if you like, but then we make a difference to hundreds more by visiting them at home or seeing them in the general hospitals.
We hold a multi-disciplinary team meeting in the hospice once a week on a Wednesday where every professional expert will discuss the patients that are here in some depth.
On Thursday I was teaching medical students in their fourth year at the Peninsula Medical School. They spend eight weeks in Oncology and Palliative care to give them experience of what it’s like to manage this complex group of patients. We address the question of what is the essence of a good Doctor. It’s down to communication skills, it’s listening, it’s examining, it’s balancing risk and benefit and doing the best you can for the patient in front of you.
I should have been going to Taunton as well this week, but couldn’t because of the teaching. We’re involved in a research project for the patients with the spinal catheters because we’ve got some of the best experience in the country. We’re involved with colleagues in Gloucester looking at how the technique we’re using impacts on the patients and their relatives once they’ve had it done. We know it helps ease the pain, but we also want to know if it makes a difference to their quality of life.
Friday there’s the ward round but also another multi-disciplinary team meeting for those people who are out on the ground, like the specialist community palliative care nurses. They don’t have Consultants with them so we provide that support. They tell us about the patients they are seeing and bring information about any they are worried about and we’ll give them advice, or arrange a domiciliary or out-patient visit.
I think you can already see that the range of work I do stretches far beyond the care of the patients that are actually in the hospices. Our role is to make the best difference we can to as many people as possible.
I went in to medicine because I wanted to make a difference and the reward for getting something as right as it can be for people with life limiting illnesses, is immense. A document was published last year called ‘One chance to get it right’ because if we get it wrong, we don’t get the opportunity to go back. For me it’s about making it as right as it can be for every single person who’s dying.
The benefit of experience can’t be underestimated either, so all those years I have spent in this field are now invested in the future. I sit on a national committee as a Medical Consultant representative because I believe I have a responsibility to look after vulnerable people in society. People who are dying are vulnerable and deserve the best care.
As I write the UK has come out as the top provider of palliative care in the world (Economic Survey of 80 countries) and that’s fantastic, but I would worry if we weren’t because we were one of the main initiators of palliative care medicine. Our responsibility now is to nurture and attend the services that we already have and to develop them.
We know that funding of health services is under threat and we are one of the lowest funded hospice charities in the country so we have to continue to educate people, to help them understand what we do and why and to explain the difference we make and want to continue to make.