David has seen the work of St Christopher’s Education Centre manifest in hospice care in the UK and abroad. He said: “I like to think what we learn and what people learn from us is how to really work with strengths and resources. I am drawn to the concept of resilience and how this is played out in different settings.”
When David himself was a participant on the Multi-Professional Week, Elizabeth Earnshaw-Smith, then St Christopher’s director of social work, told him: “Hospice and palliative care is all about strengths and resources, including the patient and their families; drawing out patient, family, team and community strengths and resources and harnessing them for the best possible benefit.”
“Not all of the patient is dying,” David tells me, “I really believe that. Of course a person is dying physically, but I believe in enabling people to be active in their care. People have had life experiences, they bring up children, they contribute to their community; they’ve got all that to give, even if their bodies are not behaving. There is so much we can do alongside them, or with them in terms of doing last things, entering new relationships. Even using the experience of being in the same boat as other patients is so important.”
To illustrate this, David tells me the story of coming to a User Forum meeting on the day of the London bombings in 2005, having just heard that his son’s girlfriend couldn’t be contacted and that many were feared dead. He was due to meet with a group of patients, most of whom were very much at the end of their lives. Upon seeing David’s distress in his face, one of the patients, a young woman, dying with a brain tumour, asked him: ‘Are you ok? We don’t have to do this now, we can postpone it.’
“It was an ‘I-Thou’ moment,” says David, “a moment when you connect with the patient, which makes you wonder who is the helper and who is the helped.
“I often think of that young woman and how she could reach out to me when we were especially preoccupied. I think of her in terms of how much patients still have to give – and how they can be a therapist to us!”
In David’s opinion, the most important lesson for hospices to take forward into the future is how to bridge research and practice and to keep a close link between these vital areas. He says: “We need to learn more how to do practice-based research, to study things that are going to be really useful in making a difference to people’s lives. We need to be learning all the time the implications for service configuration and practice. Hospices need to think about the changing demographics, the frailty agenda, how to get services all linked in together.
“I know that is am biased,” says David, “but to me education is the key. It is the fuel that drives palliative care.
“We all need to focus on the agenda to improve end of life care services for everyone in whatever setting they are in. Far gone are the days where we did deluxe dying for the few. End of life care is now rooted in all areas of medicine.”
David points out that hospice and palliative care professionals are now part of a network, they don’t have to offer the full package of care, but can make an impact by sharing their skills and knowledge with other colleagues. He says: “I think the ability to give and share one’s skills, whether you are a music therapist, a doctor, an occupational therapist… to take some of the skills and insights that you have and to share them with other staff who have contact with people who have advanced illness.”
He also believes that it is necessary to rethink the role of volunteers in the UK; that these roles do not have to just support the clinical work of the hospice. Hospices need to take advantage of the different skills available and use volunteers in creative ways. He says: “I think there is more mileage there. We need to have more flexible schemes. There is probably a huge range of differing volunteer training for different tasks that need performing with patients, and not necessarily clinical involvement.”
David notes the vital importance of making the general public aware of the services hospices offer. He says: “It’s also public information, changing the culture. Dying Matters need to be applauded for giving the message to the public that it’s good to talk about dying and bereavement.”
Finally, David emphasizes that: “Sometimes we do complexify situations rather than just hold onto the fact that there are some simple things that we can do to make a difference.”
David notes that hospice and palliative care work is about: “attending to endings, and helping people say: ‘Sorry, thank you and goodbye,’ if they wish to and in their own unique way.”
For David, this act of expressing sorry, thank-you and good bye is unique for each person and each family. “It cannot be a prescription,” he says, “but it can contain reviewing life, maybe making reconciliations, saying the unsaid.
“’Thank-you’ may involve appreciation, affirmation, the chance to show love. And in: ‘Goodbye’, in all of the contradictions, the endings can leave you feeling stronger, certainly for the families remembering that moment. I do believe palliative care is about the messiness of life and is full of contradictions, paradoxes, and ambivalence. It’s full of shades of grey, not black and white. So we experience on a day to day basis the depths of sorrow and sadness mixed with joy and almost exhilaration.”
David ends the interview with a quote from Nathan Cherny, palliative care physician and advocate from Israel, saying: “’There is an underlying optimism at the heart of palliative care’, and that is there in the people who do it both clinically and non-clinically; there is hope, they laugh, they enjoy themselves, and that is quite catching.”
David Oliviere is one of the people without whom the field of palliative care would be very different to what it is today. Not only has he contributed by sharing his own learning through academic papers and conference plenaries, but he has also inspired new generations of leaders to guide the development of the discipline throughout the world.
ehospice wishes David well in his retirement and thanks him for his unwavering support over these past months.
If you wish to contact David, you can email him at email@example.com
Read the first part of David’s interview on ehospice.