A Good Death

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    • 00:01

      [MUSIC PLAYING]

    • 00:21

      DARRYL CALVER: Now I know this is a hard question for you.I know you've had difficulties tryingto give me an answer before.But have I still got my two years?Is my two years still a possibility?

    • 00:34

      DR. DAVID GOLDSTEIN: The honest truth is no.

    • 00:36

      DARRYL CALVER: No.

    • 00:45

      NARRATOR: Around 75% of deaths are expected.Yet few of us confront the inevitable.

    • 00:52

      DR. DAVID GOLDSTEIN: Certainly in Western societies,death is still regarded as an unnatural event thatsomehow can be put off.

    • 01:00

      PROFESSOR KEN HILLMAN: I think for many doctors, perhaps evenmost doctors, death represents failure.

    • 01:05

      DR RICHARD CHYE: I think a lot of doctorsfind it very hard to say you are dying.

    • 01:12

      NARRATOR: When modern medicine has nothing more to offer,when cure fails-- who cares for the dying?

    • 01:21

      WOMAN: How's that pain that you had?

    • 01:22

      PATIENT: Still there.

    • 01:23

      WOMAN: You've still got it?

    • 01:23

      PATIENT: Yeah.

    • 01:24

      WOMAN: OK.

    • 01:26

      NARRATOR: Tonight on Four Corners,coming face to face with death.In an act of courage and generosity,four Australians have allowed our camerato record the end of their lives.

    • 01:39

      DARRYL CALVER: I mean, we talk about the journey of life, lifebeing a journey.Well, what about the journey of death?Isn't that a journey as well?

    • 01:51

      NARRATOR: And we meet those who are determinedto give them A Good Death.

    • 02:13

      NARRATOR [continued]: [PEOPLE TALKING]

    • 02:28

      NARRATOR: This is no ordinary hospital.

    • 02:30

      MAN: Cheers.

    • 02:40

      NARRATOR: Two cats, Dex and Morph,named after the drugs dexamethasone and morphine,roam the wards.Patients are allowed to smoke and families can stay all day.The patients at Sacred Heart Palliative Care Unit,

    • 03:01

      NARRATOR [continued]: a part of St. Vincent's Public Hospital in Sydney,are all dying.

    • 03:06

      THERESE COMPTON: It's a privilegeto be with people at this time in their lives.It's a beautiful place to be, actually.It's a lovely place to work.It's a lot of life here, amongst the death,there's a lot of love.You're in the system. [THERESE COMPTON, RN,SACRED HEART PALLIATIVE CARE]

    • 03:22

      LOUISE EVANS: John?How are you today? [LOUISE EVANS, RN, SACRED HEARTPALLIATIVE CARE]

    • 03:25

      NARRATOR: The staff here have madecaring for the dying their life's work.

    • 03:30

      LOUISE EVANS: They're at the end of their life.But they're so appreciative for everything that you give them.So it's a privilege to look after themand help them and just give them that little bit of TLCthat maybe they wouldn't get in the acute setting,because nurses don't have time.

    • 03:51

      DR RICHARD CHYE: I think all doctors shouldbe able to do palliative care. [DR. RICHARD CHYE, DIRECTOR,PALLIATIVE CARE] And the specialtyhas grown because all doctors don'twant to do palliative care.They want to focus very much on the diseaseitself and therefore not as much on care.They are going to give you some radiotherapy today,to your back.

    • 04:12

      NARRATOR: Sacred Heart's Palliative Care director,Dr. Richard Chye, and his staff, arewell-practiced at delivering bad news.It's an essential part of the job.

    • 04:23

      DR RICHARD CHYE: Is this pain when I push?I think a lot of doctors find it very hard to say you are dying.A lot of doctors can't say no to patients' families, very hard.And it's not an easy thing for doctorsto actually say, no, I can't give you any more treatment.I tell my patients that I know I cannot cure you,

    • 04:46

      DR RICHARD CHYE [continued]: but I can make you feel better.

    • 04:49

      INTERVIEWER: And a doctor can't do that?

    • 04:51

      DR RICHARD CHYE: A lot of doctorswould just say, I can't cure you, full stop.Whereas I would say, I can't cure you,but I'll look after you.I will walk with you.

    • 05:15

      PATTY SMITH: On the 16th of June,they hit us with the one sentence,which contained four things, which was your mother hascancer. [PATTY SMITH, NORMA ANDREWS' DAUGHTER] That wastotally out of the blue.She has cancer, it's terminal, it's inoperable.And she has days, possibly a few weeks left.

    • 05:40

      PATTY SMITH [continued]: I mean, ay-yi-yi.

    • 05:46

      NARRATOR: Like most of the patients here,Norma Andrews was diagnosed with terminal cancer.She came to Sacred Heart in June last year, accepting her fate.

    • 05:59

      NORMA ANDREWS: I feel very lucky that youcould be told like that and I bypassedall that nasty stuff, the chemotherapy and everything.They said it wouldn't do any good.And there's no need for that.

    • 06:20

      NARRATOR: But Norma Andrews has been waiting to die ever since.

    • 06:25

      NORMA ANDREWS: I just wake up every morning.I say, oh, God, I'm here again.And I just go to sleep every night,and I just hope I won't wake up.It's the truth.

    • 06:42

      PATTY SMITH: Hello, mama.

    • 06:44

      NORMA ANDREWS: Hello, Patty.

    • 06:45

      PATTY SMITH: How are you today?

    • 06:47

      NORMA ANDREWS: Very good, thank you.

    • 06:49

      PATTY SMITH: Doing all right?

    • 06:53

      NORMA ANDREWS: Lovely to see you.

    • 06:55

      NARRATOR: Patty Smith is Norma's only child.This is Patty's sixth journey from her home in Perth to visither mother since the diagnosis.

    • 07:07

      PATTY SMITH: This used to be your shirt.

    • 07:08

      NORMA ANDREWS: Yes, I know.Come here, let me fix the collar.

    • 07:13

      NARRATOR: With her mother's death imminent,Patty was given the task of organizing Norma's funeral.

    • 07:19

      PATTY SMITH: It wasn't an easy thing to do,but it's better to have something practical to do.Things like-- what date would you like?That's a hard one.The coffin, the flowers, floral arrangements, what notices

    • 07:40

      PATTY SMITH [continued]: will we put in the paper.So when we get back to the hospital, what does my mum say?What are we having to eat?We got a couple of menus.We kept it fairly simple.Pork and ginger spring rolls with chili lime dip.

    • 08:00

      PATTY SMITH [continued]: Crumbed calamari with tartar sauce.Vegetarian risotto bowls with provolone--

    • 08:19

      DARRYL CALVER: I mean, I'm active.I'm not as active as I used to be.But there's still a lot of things I want to do.[DARRYL CALVER, 46 YEARS, PANCREATIC CANCER]Family-- family's become a big issue.You tend to take family for granted a lot of the times,until something like this happens.My mother and I had not spoken for 15 yearsuntil what happened.And now when it's the end, we're best of friends again.

    • 08:47

      NARRATOR: 46 year old Darryl Calver and his partner MargieHowes planned to travel.

    • 08:56

      MARGIE HOWES: Traveling the world--that's what we hoped to do.Our lives would be just traveling and visitingdifferent places.And well, but it wasn't meant to be.

    • 09:12

      DARRYL CALVER: Wherever you're going, I'm going your way.We thought we'd be in it together.And so that was our traveling song.Well, I'm traveling, and I'm gonna have to wait.

    • 09:25

      WOMAN: Number 60?

    • 09:26

      DARRYL CARVER: Yes, thank you.

    • 09:33

      NARRATOR: It was only last May Darryl Calver, a shift,was told he had terminal pancreatic cancer.Darryl began chemotherapy to reduce the tumors growingin his abdomen.

    • 09:47

      MARGIE HOWES: We found that the chemo reallydid him a world of good. [MARGIE HOWES, DARRYL CALVER'S PARTNER]He had really no-- not many side effectsas people do from the chemo.And the chemo that he was having seemed to agree with him.It was keeping the tumors at bay, whichwas giving him quality of life.

    • 10:03

      DARRYL CALVER: There's a lot of times that I do feel fine.And I can go and have a nice quiet dayand I can play some pool, have a bet on my horses.You don't really come to terms with it until such timeas you feel the pains and you know that you are not well.

    • 10:20

      NARRATOR: When Darryl's pain became unbearable,his oncologist referred him to Sacred Heart.

    • 10:26

      NICOLE: Hi, Mr Calver.I'm Nicole, and I'm from the pharmacy.These are all your medicines, and thisis a list of them, and when you've gotto take them during the day.OK?

    • 10:42

      NARRATOR: Darryl spent the past two weeks in Sacred Heartin an attempt to get his pain under control.

    • 10:48

      NICOLE: Now there's a week's supply in here.

    • 10:50

      NARRATOR: Today, he's going home.

    • 10:53

      DARRYL CALVER: I believe, quite honestly,that I've got probably 18 months left.And I want to make the most of those 18 months.So palliative care, anybody that canhelp me get over these pains-- and Idon't care what it is I have to take, legal or otherwise.Stop the pain so that I can go outand enjoy my last 18 months, here on where we are.

    • 11:18

      DARRYL CALVER [continued]: Hopefully, I won't have to come back.But the door, I've been told, is open,if I need to come back for anything else thatneeds to be done.

    • 11:27

      LOUISE EVANS: We do have patientsthat come over here for convalescence care,and short term care.And we nurse them through the symptoms.And then we see them go home.And that's an amazing achievement,to like send them home, feeling much better.So to actually see people walk out the door,

    • 11:52

      LOUISE EVANS [continued]: it's really rewarding.

    • 12:07

      JOHN RICHES: You've got your wallet in there?

    • 12:09

      SANDY RICHES: I do, darling.Thanks.

    • 12:11

      JOHN RICHES: Got some cash?

    • 12:12

      SANDY RICHES: Yes, I have some cash.

    • 12:17

      NARRATOR: Sandy Riches and her husband Johnhave recently celebrated their fortieth wedding anniversary.

    • 12:25

      SANDY RICHES: It's my beautiful ruby ring.And I thought, if I can hang around till my 50,he might buy me a really big diamond one.I don't know what's gonna keep me.I'm very determined to just be with my husbandas long as I can be.Because I know when I die, when I've moved on from here,

    • 12:49

      SANDY RICHES [continued]: I don't know what's going to happen to him.So I've got to be here for him.I can't imagine him without me.

    • 13:05

      JOHN RICHES: Just arrived.

    • 13:10

      NARRATOR: Sandy is on her way to Sacred Heart.She is one of around 250 patientswell enough to remain at home.Sandy was first diagnosed with aggressive breastcancer in 1992.

    • 13:32

      SANDY RICHES: Well, I think we were all a bit gobsmacked.Because we weren't really expecting-- we thought,oh, it can't be happening.I'm too young to have breast cancer.Because I was only about 46.

    • 13:43

      NARRATOR: Sandy enjoyed 14 good yearsbefore the cancer returned.In 2006, she was playing her weekly game of tenniswhen her doctor called.

    • 13:55

      SANDY RICHES: And he said what are you doing at tennis?And I said oh I play tennis every Friday.And he said, no, you have to come in straight away.So she said, yes, it's metastasized breast cancer.And it's in your liver and it's your lung,and it's in your brain.And you've got a place in your hip, that sort of thing.

    • 14:21

      NARRATOR: Today Sandy is at Sacred Heart's day center,where she'll spend time with other patients whoshare her trauma.

    • 14:31

      SANDY RICHES: It's mental anguish.You wake up every morning and thank God I'm still here[INAUDIBLE].And it's a mental anguish that yougo through when you have cancer and you know it.

    • 15:01

      NARRATOR: Diversional therapist Kate Roger's jobis to keep patients' minds off their illness.

    • 15:07

      SANDY RICHES: Oh.

    • 15:11

      KATE ROGERS: You never know what I'll find in the back cupboardsometimes.

    • 15:14

      SANDY RICHES: My goodness.Oh, that's last year.Yes, because Irene and I both wore our wigs

    • 15:26

      KATE ROGERS: Aging mythology and allthat-- it's the ferry that shepherds people who aredying over to the other side.And I think everyone in palliative carehas their own little place on that ferry.I'd say my place would be the cruise directoror the activities director.Having all those sort of fun activitieslike the parties or the shuffle board or the bingo

    • 15:48

      KATE ROGERS [continued]: or with balls or wee bowling or anything like that.So it's make them have fun.

    • 15:56

      WOMAN: So we're going to take you up.I think we've been to about, seen each other aboutthree Christmases now.Go, girl.That's what we are all about.

    • 16:08

      SANDY RICHES: If I had to die in there, that's what I'll do.I'll die in there or I don't particularlywant to die at home.

    • 16:16

      WOMAN: Why is that?

    • 16:17

      SANDY RICHES: I don't want John to look across the bedand think-- she died here.I don't want that for him.

    • 16:39

      NARRATOR: Father of three John Peart was a keen sportsmanwith a larrikin streak.He was also a successful painter and decorator.He was first admitted to Sacred Heart Palliative Care

    • 16:59

      NARRATOR [continued]: Unit in May 2009.

    • 17:03

      REECE PEART: The day we heard the word palliative I actuallylooked it up on Wikipedia.And the definition's quite shocking.Like it--

    • 17:11

      WOMAN: What does it say?

    • 17:12

      REECE PEART: It says final life final stages of life care.

    • 17:17

      KAY PEART: When Reece looked it up, we sort of said,you know is there something we don't know?And he said, no, he's only to manage his pain at the moment.[KAY PEART, JOHN PEART'S WIFE]

    • 17:26

      REECE PEART: But we never mentionedthe definition to Dad, just to keep his mind at ease.Because it was that bad.It was very, very bad.

    • 17:34

      KAY PEART: He said I keep making friend in herebut they all die.

    • 17:42

      NARRATOR: As the cancer spread and the painbecame unendurable, John was re-admitted to Sacred Heart,in early December last year.

    • 17:51

      JOHN PEART: You know the bag worked.It's still working.There's plenty of gas, gas and air coming out of it.And I could eat the legs off a horse.

    • 18:01

      DR. KATHERINE CLARK: Could you?

    • 18:03

      JOHN PEART: I'm so hungry.

    • 18:04

      DR. KATHERINE CLARK: He's gassy. [DR. KATHERINE CLARK,PALLIATIVE CARE SPECIALIST] He demands answers.He tricks me on a regular basis.He's crook.You know, I never quite know what I'm going to find next.

    • 18:19

      NARRATOR: John is one of Palliative Care Specialist Dr.Clark's more challenging patients.

    • 18:24

      DR. KATHERINE CLARK: We don't want anyone to be in pain.And pain is one of the most feared complications of cancer.

    • 18:29

      JOHN PEART: Sciatic nerve pain's incredible.

    • 18:31

      DR. KATHERINE CLARK: It's awful.

    • 18:33

      JOHN PEART: I wouldn't wish it on,wouldn't wish it on my worst enemy, how bad it is.If I could bottle it in wars and throw out it other countries.The other country would win because the rest of themwouldn't be able to do anything.That'd be the end of them.Ah, it's terrible.

    • 18:55

      MAN: Just some John.

    • 19:00

      DR. KATHERINE CLARK: John has very complex pain.He has a very large mass occupying a lot of his pelvis.He has pressure on something called the lumbosacral plexis,which is a plexus of nerves that have come outfrom the spinal cord.

    • 19:17

      NARRATOR: For the staff at Sacred Heart,making sure patients like John are pain-free--and at the same time conscious and alert--can be a real battle.

    • 19:27

      JOHN PEART: Look where your tailbone is, like feels like itswells up and it just throbs.Just throbbing, and it goes-- it just shoots [INAUDIBLE].It's just too much.

    • 19:43

      DR RICHARD CHYE: 99% of my patientswill be comfortable without pain.But there will be a small number of patients whosepain is difficult to control.Yes, we will go through lots of extraordinary means,medications to try and get on top of their pain.

    • 20:00

      DR. JENNY STEVENS: John has a implanted reservoir that'sattached to a catheter that goes near his spinal cord.[DR. JENNY STEVENS, ANAESTHETIST, ST. VINCENT'SHOSPITAL] And so he's got some local anestheticand some morphine in the reservoir.And that just feeds continuously into his spinal cord.And he's had that for almost a year, isn't it, John?

    • 20:23

      KAY PEART: You all right there?

    • 20:26

      NARRATOR: John's family has been forced to watch him suffer.

    • 20:29

      REECE PEART: Do you want some more, Dad?

    • 20:31

      INTERVIEWER: In this situation, it's inevitable euthanasiawill be discussed.When the pain has got crippling, had anyof you talked about euthanasia?Has John ever indicated--

    • 20:44

      REECE PEART: Oh, of course.Yeah.

    • 20:47

      MELISSA PROCHAZKA: Dad was-- dad saw his dad go through it.And dad was always strong about euthanasia,but obviously it's illegal.But his theory was that if you're in that much pain, thenyou shouldn't be sitting there suffering. [MELISSA PROCHAZKA,JOHN PEART'S DAUGHTER]

    • 21:03

      REECE PEART: He always used to sayI feel like putting a gun to my head,but we know that he was divided over that viewpoint.

    • 21:12

      MELISSA PROCHAZKA: At the same time,you know he was willing to fight.So it was a balancing act.

    • 21:19

      INTERVIEWER: What if it was available?What do you think would have happened?

    • 21:23

      REECE PEART: No doubt in my mind.Then again, like he's very variable.

    • 21:28

      DR. KATHERINE CLARK: Most people want to live.Most people want to live.There are a very small number of people,and the number is so small over my career.I've been a specialist for gosh, nine years now.

    • 21:51

      DR. KATHERINE CLARK [continued]: The number of people who remain firmly entrenched in the beliefthat they want to die and die now, it's so few.They are memorable people.

    • 22:02

      NARRATOR: Norma Andrews believes she should be allowed to die.

    • 22:05

      NORMA ANDREWS: Yeah, of course, I do.Well, if you're thinking about-- can they give me a pill?I know that that's not possible.I know it's not allowed or everything else.

    • 22:22

      PATTY SMITH: She would give anything.That if it was legal now that is her wish-- that she has doneeverything she needs to do, and that every day that goes on,she just loses a wee bit more dignity.The fact that she's been a very elegant lady all her life.

    • 22:47

      NORMA ANDREWS: What sort of a lifeis it when you've got to ask somebody take youto the bathroom every time?["O COME ALL YE FAITHFUL" PLAYING]

    • 22:55

      CHOIR: O come all ye faithful Joyfuland triumphant O come ye O come ye to Bethlehem.

    • 23:13

      NARRATOR: Sacred Hearts' Christmasparty is one of the highlights of the year.

    • 23:17

      CHOIR: Him, Born the King of Angels.O--

    • 23:23

      NARRATOR: The staff go to extra effortto ensure it's a memorable day.

    • 23:27

      CHOIR: Him, O come let us adore Him, O--

    • 23:33

      NARRATOR: They are well aware for manyhere, including Norma Andrews, thiscould be their last Christmas.

    • 23:39

      WOMAN: How's that?

    • 23:40

      CHOIR: Christ, the Lord.[APPLAUSE]

    • 23:49

      NARRATOR: As the patients at Sacred Heartenjoy the celebration, it's a sobering thoughtto know most terminally ill Australians won'tspend Christmas in a palliative care unit like this one.

    • 24:01

      CHOIR: In the frosty air.

    • 24:03

      PROFESSOR KEN HILLMAN: Approximately 70%of Australians now die in acute hospitals.Getting sick at home, put in an ambulance,coming into hospital, coming into the general wards,going into intensive care. [PROFESSOR KEN HILLMAN,INTENSIVE CARE UNIVERSITY OF NSW] It'sthat process, which has happened subtly.And it's happened without any discussion with our society,it's just what we do.And we do it for what we consider

    • 24:26

      PROFESSOR KEN HILLMAN [continued]: the best interests of patients.We want to look after them.We want to cure them.And in doing so, we've set up a situationwhere it's very difficult to die peacefully.

    • 24:41

      NARRATOR: Professor Ken Hillman doesn'twork in palliative care, but recognizesit's a vital part of medical practice.

    • 24:49

      PROFESSOR KEN HILLMAN: The patientsthat we get up to intensive care-- we're oftensurprised to find that death and dying hasn't been mentionedto the friends and relatives nor to the patient.This is often the case.Words such as-- things aren't going so well.

    • 25:09

      PROFESSOR KEN HILLMAN [continued]: The treatment that we hoped would workdoesn't appear to be working as well.It's sort of more these words, whichare dancing around the topic of death and dying.

    • 25:17

      INTERVIEWER: Do you think an intensive care unitis an appropriate place to die?

    • 25:21

      PROFESSOR KEN HILLMAN: Oh no.No.Most of us who work in intensive care, doctors and nurses,when we see elderly patients, serious illness, about to die,then we all say to each other-- pleasedon't let this happen to us.

    • 25:38

      NARRATOR: Professor Hillman works in the high techcostly end of medical care.

    • 25:44

      PROFESSOR KEN HILLMAN: I had six intensive care beds20 years ago.And they're now building me 60 intensive care beds.

    • 25:52

      INTERVIEWER: Because of the demand?

    • 25:53

      PROFESSOR KEN HILLMAN: Yes, because of the demand.That one could actually question whether that's real demandand whether the money, or some of the moneywould be better spent in palliative care units,in community support.

    • 26:11

      NARRATOR: Keeping dying patients out of intensive careisn't just good medicine, it makes good economic sense.An intensive care bed costs around $3,000 to $4,000per patient per day.A palliative care bed, like the ones at Sacred Heart,costs a lot less.

    • 26:31

      DR. KATHERINE CLARK: In New South Wales,a palliative care bed may cost as little as $600a day up to perhaps $1,600 a day,depending on the complexity of needsof the person in that bed.

    • 26:50

      NARRATOR: Despite the obvious savings,many doctors don't refer their dying patientsto palliative care.In the case of cancer patients' oncologists,they're used to referring their patients to palliative care.But the patients with terminal heart failure, liver failure,lung failure have an equally poor prognosis.

    • 27:14

      NARRATOR [continued]: And they'll die, often in a shorter time.But they're usually not referred onto the palliative carephysician.

    • 27:28

      NARRATOR: Darryl Calver is still at home.Today he's on his way to see his oncologist, Dr. DavidGoldstein.

    • 27:38

      DR. DAVID GOLDSTEIN: Darryl?

    • 27:39

      DARRYL CALVER: Hello.

    • 27:40

      DR. DAVID GOLDSTEIN: Come on in.

    • 27:43

      NARRATOR: Darryl's partner Maggie Howes joins them.

    • 27:46

      MAGGIE HOWES: Hi, Dr. Goldstein.

    • 27:47

      DR. DAVID GOLDSTEIN: Hello.OK.And so now we need to really talk.So today we were going to decide were we getting enough valueout of this chemo therapy.The chemotherapy's really kept things under control

    • 28:07

      DR. DAVID GOLDSTEIN [continued]: for quite some time, quite a number of months.But the facts are that finally this chemotherapyis escaping control.

    • 28:16

      DARRYL CALVER: So it's not helping--

    • 28:17

      DR. DAVID GOLDSTEIN: No.No.So it's significantly worse than it was last time we scanned it.But I guess what's been happening,it's been very slowly progressingduring the last month or so.And that probably explains why the painhas become more of a problem.

    • 28:37

      DARRYL CALVER: Now I know this is a hard question for you.And I know you've had difficulties tryingto give me an answer before.But have I still got my two years?Is my two years still a possibility?

    • 28:50

      DR. DAVID GOLDSTEIN: The honest truth is no.

    • 28:52

      DARRYL CALVER: No.OK.

    • 28:53

      DR. DAVID GOLDSTEIN: No.You've already down better than average for someonewith your sort of cancer at your sort of stage.It's highly likely that within the next two monthsyou will get substantially worse.

    • 29:11

      DARRYL CALVER: Within the next two months?

    • 29:13

      DR. DAVID GOLDSTEIN: Yes.Some people would say I've gotta trythe next treatment and the next irrespective of how longI've got.And other people would say, well,perhaps there are other prioritiesthat are more important to me than yet another treatmentwith 1 in 10 chance of working.And that's what I need you to think about.

    • 29:31

      DARRYL CALVER: Yep.OK.

    • 29:52

      NARRATOR: Three days later, Darryl's madea courageous decision.There'll be no more chemotherapy.Instead, Darryl will have a procedure in an effortto control his pain.

    • 30:13

      DARRYL CALVER: I mean, we talk about the journey of life, lifebeing a journey.Well, what about the journey of death?Isn't that a journey as well?Isn't part of the journey of life alsoa part of the journey of death?Aren't they one and the same thing?We are living to die.And I believe that too many people were not

    • 30:35

      DARRYL CALVER [continued]: confronted or not aware of the support thatis out there to allow you to come to terms with deathand the process that it's going to bring towards youand how you're going to manage with it.There is support.There is comfort.You don't have to do it alone.

    • 31:05

      NARRATOR: At Sacred Heart, John Peart's familyare hearing the news they've been dreading.Dr. Clark explains what to expect.

    • 31:14

      DR. KATHERINE CLARK: I really thinkthe trend is towards his life being pretty short now.I don't know how short though.

    • 31:23

      KAY PEART: We were just wonderingyou know how long it goes on like this?

    • 31:31

      DR. KATHERINE CLARK: Um, don't know for sure.But when I see changes occurring on a day by day basis,I have to wonder if life is measured in days at the moment.I wouldn't be surprised at all if John's breathing startedto change.That's very, very normal.

    • 31:52

      DR. KATHERINE CLARK [continued]: It may become noisy.If you were worried that's bothering John,then we would intervene.We would only do things if you feelthey are necessary to make him more comfortable.You may start to notice his hands become cold.

    • 32:12

      REECE PEART: Yeah, we noticed back on the weekend.

    • 32:19

      NARRATOR: The following day, to everyone's surprise,John rallies.

    • 32:27

      WOMAN: Someone sent flowers for you.

    • 32:33

      DR. KATHERINE CLARK: He did trick me.He did trick me.However, I still believe that John's overall prognosisis very poor.Each person does this in such a unique mannerthat we have to be respectful of it.

    • 32:52

      REECE PEART: It's from [INAUDIBLE] Medical Center.

    • 32:57

      JOHN PEART: [INAUDIBLE]

    • 33:15

      NARRATOR: Darryl Calver's condition has worsened.He's been admitted to Sacred Heart.Nurse Louise Evans is on duty when Darryl becomes violentlyill.

    • 33:31

      LOUISE EVANS: He's bringing up everything he takes down.

    • 33:34

      WOMAN: Can I give you a phone order for IV [INAUDIBLE]?

    • 33:37

      LOUISE EVANS: Yes.At subcut, you mean?Subcut.He was being sick.So our emergency was to try and get that sickness into control.And we'd given the maximum amount of medicationwhich we could give.So at that point it was important to get

    • 33:60

      LOUISE EVANS [continued]: a prescription for more medicationto try and control it.

    • 34:06

      NARRATOR: An x-ray reveals Darryl has a bowel obstruction.When the bowels are blocked by the cancer itself,that meant that he wasn't able to take as much nutritionas he was before.It meant that he wasn't able to drink as much as before.That's when his deterioration became much more marked, much

    • 34:29

      NARRATOR [continued]: more quick.

    • 34:31

      MAGGIE HOWES: Hi.Hi, darling.How are you going?It's like a football match.This is only 3/4 time.Game's not over yet.There's still some way to go.It's still fighting him.

    • 34:53

      DR. KATHERINE CLARK: Just being sortof tackled to the ground by a great big front row forward.

    • 34:59

      DARRYL CALVER: He's hurting.

    • 35:02

      MAGGIE HOWES: He's hurting?Is he?No.["SILENT NIGHT" PLAYING]

    • 35:38

      NARRATOR: It's 7 AM on Christmas morning.And Nurse Julie Copeland has just finished a 12 hour shift.She's updating the staff on what happened throughout the nightand whether John Peart will be home for Christmas.

    • 35:54

      JULIE COPELAND: You know he thinks he's going home today.And his wife--

    • 35:58

      WOMAN: Is he?

    • 35:58

      JULIE COPELAND: No.Oh yeah.Then I brought in, I sent a present.And as I turn around, he was awake.Oh.I never got you anything.

    • 36:11

      REECE PEART: On Christmas day, there were people there.The nurses all paid for gifts for the patients.And Dad got his panda and he named it Puff.Every time you go in there he says don't touch Puff.

    • 36:34

      NARRATOR: Sandy Richards didn't spend Christmas at home either.The cancer has returned and this time it's in her bones.

    • 36:43

      SANDY RICHARDS: I'm just so mad at this damn thing.You know I feel like saying, you were around 14 year ago.Go away somewhere else.I was in a nice little holding pattern.And that nice little holding pattern seems to be changing.And it's growing in my bones now.

    • 37:03

      NARRATOR: Sandy will have five days of radiotherapyin an attempt to keep the cancer at bay and medicationto control the pain.The pain is a damn nuisance.And there's no point in saying oh, it's not too bad.It is bad.It's damn painful.

    • 37:23

      NARRATOR [continued]: Once the pain's gone, you're right.You can get up and you can do things.You can walk.You can ride bikes and all that sortof stuff, which I will do once I've past this wretched pain.

    • 37:50

      NARRATOR: As 2009 comes to a close,Darryl Calver's journey is also ending.

    • 37:59

      MAGGIE HOWES: Last night when I was here, he was very agitated.His breathing was getting difficult.Our communication between each other wasn't-- we couldn't, Icouldn't quite understand what he was wanting me to do and hewas getting a little bit agitated with that.

    • 38:17

      THERESE COMPTON: It's just a restlessness thathappens towards the end. [THERE COMPTON, RN, SACRED HEARTPALLIATIVE CARE] It can happen and it's just the bodystarting to shut down.And it's just a restlessness will settle in.

    • 38:33

      NARRATOR: Just a month earlier, Darryl believedhe had 18 months to live.At 8:30 AM on New Year's Eve, Darryl Calver died.

    • 38:50

      MAGGIE HOWES: You're at peace now, aren't you?No more suffering.He was breathing quite shallow for the hoursthat I was here with him.And then it just slowed just to a normal breath and yeah,

    • 39:12

      MAGGIE HOWES [continued]: he did.He went peacefully.

    • 39:17

      LOUISE EVANS: A lot of people have the perceptionthat once a patient's passed away, then it's just a body.But to me, they're still my patient.And they are treated with the utmost respect.I'll still speak to them as if they were stillwith me in that room.I'll still tell them exactly what

    • 39:38

      LOUISE EVANS [continued]: I'm doing, because I couldn't bear to leave a lovedone of mine on their own.

    • 39:51

      NARRATOR: Sandy Richards is now well enough to go home.Sacred Heart's occupational therapist Alex Sidney Jonesand physiotherapist Jess Akin accompany her.Their job is to ensure Sandy and John can manage.

    • 40:15

      ALEX SIDNEY JONES: Yeah, OK.So we're going to roll you onto your side first.Ready?

    • 40:19

      JESS AKIN: This leg straight for me.So the opposite leg you're going to bend up.And then you're going to roll-- 1, 2, 3, over onto your side.Good.

    • 40:27

      ALEX SIDNEY JONES: So you're justholding on to her hips and her neck and her legsand that will help roll.And that's the first step.

    • 40:37

      NARRATOR: Sandy will soon face another roundof scans and blood tests.But for now she will make the most of being at home.I'm going to slough about and drink tea.And oh, I just want to revel in being home.

    • 40:54

      INTERVIEWER: Jonathan, what's it like having Sandy home?

    • 40:58

      JON RICHARDS: Well, it's wonderful.You're busy when Sandy's not herebecause you're up and back from the hospital.The place isn't the same.It's just like a building.But it's not a home.But it is now.

    • 41:20

      SANDY RICHARDS: You love me?

    • 41:25

      NARRATOR: Back at Sacred Heart, John Pierceis drifting in and out of consciousness.

    • 41:30

      WOMAN: Would you like to have a little drink, John?Want to try a little drink just before I go?

    • 41:57

      NARRATOR: By Friday the 15th of January,John Peart shows signs of being close to death.He develops a delirium, a symptomof his advancing disease.

    • 42:08

      DR. KATHERINE CLARK: The differenceis John has progressed over the last week.John has become-- had become more and more confused.And I think John has had a delirium for the last week.It's a very, very common scenariotowards the end of life.

    • 42:29

      NARRATOR: John is given anti-psychotic medicationto settle him.

    • 42:35

      KAY PEART: Yesterday he could say a few wordsthat you know jumped sort of under his breath.And he was talking to--

    • 42:44

      REECE PEART: Yeah, he said by to you.

    • 42:45

      KAY PEART: Yeah.He couldn't sort of say that he was in pain.It just like all of a sudden he'd come out with something.

    • 42:57

      INTERVIEWER: And he said goodbye?

    • 42:58

      KAY PEART: Yeah.And he'd sleeps move he was kissing me.

    • 43:08

      NARRATOR: Against the odds, John lived for another four days.On the 19th of January, at 1:30 in the afternoon,John Peart died.

    • 43:34

      DR RICHARD CHYE: I will come and see you, Maria.OK.

    • 43:38

      NARRATOR: Dr. Chye is on his rounds once more.The junior doctors with him are learninghow to care for the dying.

    • 43:45

      WOMAN: I'd like to go home.

    • 43:47

      NARRATOR: The harsh reality is palliative care specialists arein short supply.If.Dr. Chye has his way, care will become as important as cure.

    • 43:59

      DR RICHARD CHYE: Having young doctors understandpalliative care, and then to takethat learning that understanding back into the main hospitalto hopefully change that hospital's culture,that palliative care is not all that bad.

    • 44:20

      DR RICHARD CHYE [continued]: It's only a small step in terms of tryingto change a whole generation of doctors,but that's where we feel we need to start.

A Good Death

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Abstract

Palliative care is one of the least known areas of medicine, and death continues to be regarded as an unnatural event that can be put off. When terminal illness runs through all modern medicine has to offer, patients are left only with palliative care. This documentary follows the lives of four people who are dying, some up to their deaths.

A Good Death

Palliative care is one of the least known areas of medicine, and death continues to be regarded as an unnatural event that can be put off. When terminal illness runs through all modern medicine has to offer, patients are left only with palliative care. This documentary follows the lives of four people who are dying, some up to their deaths.

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