by Derek Doyle, MD
This news item about the Clermont-Ferrand University Hospital in Central France appeared in a British newspaper on a particularly sad, deeply distressing day when page after page was devoted to wars, killings, Man’s inhumanity to man, thousands of dead, millions of refugees, orphans, blame and counter-blame, hate, bitterness and the understandable loss of all hope. An anonymous editor had squeezed this snippet of news into a tiny space but it made compelling reading for at least one reader, once a palliative medicine physician.
Dr. Virginie Guastella of the hospital’s palliative care service came up with the idea because she believes “patients are entitled to enjoy their last days.” She plans wine-tasting sessions for patients while friends and family are able to join them. The bar will stock wines donated by local people and also have whisky and champagne.
Would I be right to say that this imaginative gesture embodies some of the basic underlying principles of palliative care? Patient-centred, focusing on what will make them happy, involving their loved ones and friends, enabling all of them to remember happy times together whilst at the same time being with them as they face up to that road that lies ahead.
How easy it is for us – health professionals – to feel at home in hospitals, at home with the sounds and the smells, at home with the language of medicine and the euphemisms we use to avoid the words that might upset or be misunderstood, at home with suffering and (admit it) with dying and death! How different it must be for our patients – those trusting people who have put themselves into our hands as they prepare for that final journey. How often and how much they must wish they were at home with family faces, in familiar beds and still with some degree of control over what is happening, in familiar surroundings with much-loved views - here we return to where we started – and able to lift a glass of their favourite wine or a drop of Scotch.
Predictably there will be some who will read this and be appalled at a retired physician approving of a modest little bar accessible to patients. “Has he never seen problems when opioids and alcohol meet?” “Is he hoping that some of the patients will “slip away” (another euphemism!) as a result of that alcohol?” Perhaps, I can hear some suggest, he is alcohol-dependent Himself!
No, not guilty. It is not the use of alcohol which tantalises or worries me but the increasing hospitalisation of palliative care; the number of health care managers facilitating good hospital palliative care at the expense of improved community palliative care, the increasing implications that good palliative care needs sophisticated care regimens, the palliative care physicians who seldom, if ever, visit people in their own homes – those homes which mean so much to those who are dying, homes full of memories well worth sharing with a compassionate listening physician or nurse.
I applaud Dr. Guastella and her colleagues. Their idea is not an Earth-shattering one but nothing we do in palliative care ever is! What our French friends are doing is sensitive, simple, and easy-to-emulate. Their heart is where we have always claimed ours are. Of course, as a Scotsman I am happy that her patients might choose a whisky, though personally I would have a very small glass of French red, particularly if I only have a few days to live. I wonder if a physician friend will drop in to see me - whether in hospital or at home - before he goes home at the end of another hectic day. I should so like to have a drink with him, but perhaps not a 40% alcohol Scotch!
Derek Doyle, MD (Scotland)
Dr. Doyle is a Founder and Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.