Compassion, Humour, and Care: Dr Ralph McConaghy’s Approach to Palliative Medicine

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[00:02:36] Kate: In today’s episode, we dive into the topic that many find difficult to discuss, but one that’s essential for patients and their loved ones. It’s around early conversations about serious illness and the end of life decisions. So join us as Mary Anne Skiparis has a conversation with Dr. Ralph McConaughey, the Medical Director of the Palliative Care Service at the Wesley Hospital in Brisbane.

[00:03:03] Dr. McConaughey brings years of experience and a wealth of insights to our discussion on the importance of open communication, misconceptions about palliative care, and finding dignity in life’s final chapter. We’ll explore the emotional challenges of this work, the reward it brings, and the transformative power of these conversations for both patients and their family.

[00:03:29] So whether you’re a patient, caregiver, or healthcare professional, we invite you to join us for this thought provoking and heart opening conversation.

[00:03:40] Maryanne: Hello, my name is Mary Anne Skiparis and I welcome here in the studio this afternoon with the Talking Blood Cancer podcast, Dr. Ralph McConaghy. Hi Ralph, thank you for joining me this afternoon.

[00:03:55] Ralph: Hi Marianne, it’s a pleasure.

[00:03:56] Maryanne: with a healthcare professional as you are, I’m just wanting you to share with us what do you love about the work that you do and what is your official title over there?

[00:04:08] What work do you do?

[00:04:10] Ralph: Okay, well, official title, I’m the Medical Director of the Palliative Care Service at the Wesley Hospital in Brisbane. which some of your listeners will probably know is a private hospital and one of the few private hospitals with a bone marrow transplant unit. And so my role is really supporting patients who would be in that environment, really in two ways.

[00:04:35] The majority of the time it’s what you would call symptom control. So I’m really responsible for helping people, with distressing symptoms, pain, nausea, constipation, emotional distress, all those areas. We would try and assist to make them as least horrible as possible. And of course other component of my job is people.

[00:04:54] Approaching end of life where really what we try to do is give people a gentle landing and avoid the worst that might happen to them in time.

[00:05:04] Maryanne: What do you love about the work that you do?

[00:05:06] Ralph: Well, I had this thing in my mind, you know, of a glider coming into land on a green field in England on a warm summer afternoon. That’s how I like to think we allow people to come to the end of their life. That it’s a gentle, peaceful and calm process. That’s it. Hopefully respects their individuality and respects them as a person.

[00:05:27] Maryanne: They’re being a visual thinker as I am. I really love that vision.

[00:05:32] Ralph: yeah, it’s sort of nice, isn’t it? Anyway, that’s just my vision of it, I suppose. Or another way is sort of building a bridge across a raging torrent and you, you get people from one side to the other without having to wade through the awful components in between.

[00:05:48] Maryanne: That’s true. Very true. there any particular life experience that you had that led you to that specialty area or it was always something that did appeal to you or?

[00:05:59] Ralph: Well, I started off as a GP

[00:06:02] and I sort of became a GP by default, slightly. but I wanted to be a doctor that could manage all aspects of people’s care. So, not enough just to be able to deal with a sore throat. I did a lot of training and in fact I had a job to be a country superintendent in Queensland, and, you know, I could do a burr hole, drill a hole in someone’s skull, I could take out an appendix, I could deliver babies, I could take out a gallbladder, I could do lots of stuff, and my first wife unfortunately was diagnosed with a brain tumour, and so I didn’t do that.

[00:06:34] And I went into suburban practice in Brisbane, and so, the role I took on there was the next best thing to being an all round doctor, which I always think a country doctor is, so, and that was my desire, was really to be able to I deal with a lot of aspects of patient care. So when I was a GP, I used to assist in operating theatres.

[00:06:57] I did my own obstetrics. I used to deliver my patient’s babies. And I was the last doctor in Brisbane who did that. And there were lots of things I did that made me feel I was well rounded. One of the things I did was care for a young child with leukemia in 1988. And a rarity then, and possibly even rarer now, was that her parents wanted her to die at home.

[00:07:22] so my partner in general practice and I provided that care at home, because there was nothing organized for community support for anyone dying from cancer in those days. And we saw that family through to that day. and then supported the family for probably another 15 years after that as part of our general practice.

[00:07:42] And I think we did an okay job. I think certainly the family felt they were well supported and I think that little girl died as comfortably as we could. conceive her being. But it made me think, you know, people should do this really well. This is something really, really important about health care, that we need to be caring for people as they approach the end of their lives.

[00:08:04] And so really from then, that set me on the path to find out more about palliative medicine, what more I could do as a GP. And that led me down to some time overseas where I did some specific training. I did two master’s degrees. I did a whole lot of other stuff. And in the end, left general practice just after 2000 and became a full time palliative care specialist. So it was a long journey, probably 13, 14 years of study before I felt that I was ready to change specialties.

[00:08:37] And there I am.

[00:08:39] Maryanne: there you are. But what lovely grounding insight, I guess, having embraced or being passionate about embracing so many aspects of the general practice, but going above and beyond Ralph for that little girl and her family.

[00:08:54] Ralph: Yeah, I think we did. I think we did. And, you know, and you did sort of say, what is it that I get? What do I like about what I do? Or what do I find positive for me? think in simple terms, I can come home at the end of the day and think, I did a good thing today. And that’s really, really makes a difference to me because my days are long and they’re difficult

[00:09:21] Speaker 2: um,

[00:09:21] Ralph: full of fraught emotions, my own and patients and families.

[00:09:26] And if you can’t come home at the end of the day and say, I did something good for my patients, I don’t know how you survive in the specialty.

[00:09:34] Speaker 4: very

[00:09:35] Ralph: you have to feel there’s a reward for me is knowing that I’ve helped someone. That sounds really corny, doesn’t

[00:09:42] Maryanne: No, it? doesn’t sound

[00:09:43] Ralph: But that’s the truth of it, I think.

[00:09:46] Maryanne: you touched on you lost your to a brain tumour. So I guess in some ways you’ve been on the receiving end of what you’re now giving or have insight to what the need is. Personal insight

[00:10:00] Ralph: yeah, I think it’s, Yeah, it was a very sudden end and so palliative care wasn’t really involved, but, I think by the time that she lost her life, I’d already finished my first master’s degree, and, I think it gave me insight into the kind of suffering people endure and what families are left to cope with, and I don’t think it was necessary, right, for me to become who I am.

[00:10:26] I don’t think I needed that to happen, but. But I think it, it has been helpful in that sense that I have a comprehension of what it’s like, and what it’s like for families. And so I guess I have an empathy

[00:10:40] Maryanne: have an

[00:10:41] Ralph: situation.

[00:10:41] Maryanne: Yeah, absolutely.

[00:10:43] Ralph: Or, a bit more empathy.

[00:10:45] Maryanne: Well, yeah, insight and empathy into what those emotions might be like for someone and the family members

[00:10:53] facing the end of life.

[00:10:55] Ralph: Yeah. I think so.

[00:10:57] Maryanne: What a lovely, rich life experience that

[00:10:59] Ralph: Oh, you’re very kind.

[00:11:01] Maryanne: Yes.

[00:11:02] Ralph: Well, you know, medicine’s a great career, at least for me, and it’s one of the things I think I enjoyed about general practice and I enjoy about palliative medicine is people, it’s not just, hello doctor, I’ve got a broken leg, can you fix it up? It’s more, hello, come into my family and come and sit with us and come and meet who I am as a person and let’s work together.

[00:11:25] to make the best outcome. and you don’t get that invite in a lot of medicine,

[00:11:31] Speaker 3: No.

[00:11:31] Ralph: do in palliative medicine, and you do in general practice, and you get to meet human beings. And one of the things is a guy called Harvey Chochanov, who you may not have heard of, he’s a Canadian psychiatrist who does a lot of palliative medicine.

[00:11:45] But his whole thing is about dignity therapy, that we have to help people regain the dignity they have as human beings when they’ve been dissolved into being patients. And one of the things about being as a patient is we take away some of your dignity and some of your humanity so we can control you.

[00:12:05] In that way that hospitals do. And so part of my job is bringing people out of being a patient and restoring their humanity and their And so being able to do those things I think is tremendously rewarding.

[00:12:21] Maryanne: It would be tremendously rewarding.

[00:12:23] Ralph: and to have people let you be with them. You know, because that’s not something that everyone lets doctors do.

[00:12:32] And I think it’s tremendous responsibility and, the bit about patient care that’s so important for me is I meet people. And, um, I think the other thing is, well two things. One is I prattle on a lot, which you’re just discovering. but secondly, I think the other thing I enjoy is talking about love with patients.

[00:12:52] And that’s something you don’t usually do in medicine. For

[00:12:56] Maryanne: No.

[00:12:56] Ralph: But one of the key factors where people are in, in their illness is talking about love’s really important and talking about what they love as individuals, but who loves them, who do they love, how does love translate in their life, and how do we keep that love central and help it to be as rich and as deep as it should be.

[00:13:18] So my whole job is not about giving drugs.

[00:13:21] Speaker 3: No.

[00:13:21] Ralph: you, I do like a good drug, right? I really do. Ask me on a Friday afternoon. But, you know, I think a bit of what we do is that intangible part of life, is really wanting to understand the total human being, rather than just tell me about your back pain or tell me about your crush fracture, or what those things are.

[00:13:44] It’s how does that thing then integrate into your life and how does it affect your relationships? How does it affect how you can function? How does it affect the things you really want to do? So I guess it’s trying to take that same general practice approach of understanding the person rather than just that little thing that we’re worried about right at that time.

[00:14:05] Maryanne: And look, must say, I think that that’s the value of you, Ralph, not everybody does that, but I do congratulate you on looking at the whole picture and that’s very much how people that I know who have been in your care or who have had their loved one in your care. have said out loud about you, how, how safe they have felt, how, you know, nurtured they have felt and how listened to.

[00:14:29] So I, congratulate you on everything that you’ve shared there, because I do think that that’s that holistic approach to an individual and something that you certainly through your empathetic lens, through what life experiences have taught you that you then give back. been any pivotal moments throughout your career, both as a GP a, palliative care physician?

[00:14:53] Have there been any pivotal moments that you believe have been life changing or that have fine tuned your direction in the care that you provide? Mm

[00:15:03] Ralph: It’s hard to think. can think of that in general terms. I can’t think of necessarily really individual moments.

[00:15:11] Maryanne: That’s alright

[00:15:12] Ralph: I think sometimes there’s a couple of things. I think first is the negative side of that. And that is if you stuff things up, you know, and things don’t go the way you had hoped, or if you don’t deliver what patients expect from you, as long as their expectations are realistic.

[00:15:31] I think that very much makes you reassess how you work, makes you reassess how you communicate. So there’s been times like that where I’ve realised maybe I’ve said the wrong thing, or I haven’t been clear enough, or I’ve misinterpreted. And so they’re pivotal moments. They’re painful and they

[00:15:50] hurt

[00:15:51] and you carry those.

[00:15:52] You know, you can do a hundred good things for families and you do one that doesn’t work and that’s the one you remember. And that’s the one you take home. It is, but I think it’s common to most of us in medicine. You, your failures or your disappointments are the things that sit closest to you. so there’s lots of little moments like that where you don’t get it right.

[00:16:17] And they’re very instructive and it’s disappointing, I think the other pivotal moments are things really Where I’ve done a really, really good job. It’s the other side of the coin. And more often there, I suppose what I’m thinking about are people who’ve had pain that no one can sort out. Or that others have tried and failed.

[00:16:37] And when you think a bit laterally, when you use other people’s abilities, and you actually resolve that for people. That’s such a good feeling.

[00:16:46] Speaker 3: Yes, it would be.

[00:16:48] Ralph: And it really makes you think, I can do this and bring on the next one because I can face that challenge. So there are pivotal things like that, that stay with you, but I can’t give you really clear ones.

[00:17:01] Maryanne: okay?

[00:17:02] Ralph: The only, probably the other thing that occurs to me, maybe as difficult as it might be for your listeners to hear, is the death of young people. And, I find each of those, they stay with me. and I find them tremendously challenging. And,

[00:17:18] Maryanne: I ask, what is it about that scenario that you find the biggest challenge?

[00:17:26] Ralph: I think part of it is seeing your own children

[00:17:28] Maryanne: Yes.

[00:17:29] Ralph: seeing your own family in the face of those young people. And I think sometimes trying to make sense of their life, because I think that’s a big component of what they will, not necessarily ask of me, but they’ll be thinking about is, well, why? Why does my life finish at 19 or 22 and not 92?

[00:17:52] And what’s important to me,

[00:17:54] Speaker 4: Yes.

[00:17:58] Ralph: need to get my grade 12 mark. And so goals and what’s important in life are so different. And it’s trying to help those young people, I think, bring life to a conclusion where they find some peace in that time. And I find that really, really challenging. I think the other thing, sometimes you see a transformation in those families where, almost like the parents and the young person trade places, and sometimes as that young person finds peace and finds acceptance, that they’re actually being parenting their parents to come to that same place. I don’t know how that happens. And I often thought if I did a doctorate, like a PhD, that’s the thing I’d like to understand. And that’s how that role reversal might occur, where the comfort is given from the person who’s dying, they provide the comfort to the people that They’re leaving behind, and I find that a fairly miraculous transformation.

[00:18:56] It doesn’t always happen, but it’s one of life’s curiosities to me, I suppose.

[00:19:01] You know, but each of those is a transformative moment for me. I think when those things happen,

[00:19:06] Maryanne: Yeah. And you know, you mentioned earlier, the value of, love and probably in that transition, That’s the foundation that’s the pivotal point where they make that,

[00:19:21] Ralph: Yeah, I think. and it’s the source of all the pain at the same time,

[00:19:23] isn’t

[00:19:24] it? You know,

[00:19:25] Maryanne: mm,

[00:19:25] Ralph: it’s the, it’s the separating of the people who love each other that’s so difficult. So it’s, yeah, I find that really challenging.

[00:19:33] Maryanne: yes it is, now that you bring it up. Um, and you would see in your role, the variety of ages and how end of life is impacted also the dynamics of family, you know, relationships

[00:19:46] held.

[00:19:47] Ralph: And, some of it’s fabulous and some of it’s really hard, you know. and families don’t change their spots because someone in their family. dying, or suffering. And sometimes it magnifies both the positives and the negatives of those relationships, you know. And it brings things into sharp focus, both ways.

[00:20:07] which makes, you know, makes for an interesting relationship for all of us,

[00:20:11] Maryanne: Yes. Being a part of that, you know, being the person that they’re looking to, all of them, in that scenario, they’re looking to you for solutions,

[00:20:23] Ralph: of things and well outside what I can do, I think, yeah,

[00:20:29] Maryanne: absolutely. we also ask if, from your perspective, having managing and supporting, those conversations and from a patient’s perspective, especially when they’re lucid and they know that things aren’t, you know, they’re traveling well and they know that their disease is going to, um, take their life.

[00:20:48] and maybe the family’s not accepting of. Of that, or they might be choosing themselves to say, I don’t want to try any more treatment. You know, those difficult moments where, you know, some people say the carrot is dangled and there’s two pathways and you’re at the fork in the road. Are you a part of those conversations?

[00:21:09] Do you find those conversations difficult when you’ve got that conflict of opinion, I

[00:21:15] Ralph: I think it’s hard sometimes because, in a way what you need is everyone in that person’s treating team to be on the same page, you know, and I think very often, particularly in haematology. Or as I like to call it, runny cancer, right, as opposed to lumpy cancer, by and large. there’s a tremendous desire from hematology to keep offering treatment. And I think it’s because every now and then they get a dramatic result. And it’s fabulous when that happens. The hard part is I think sometimes there’s the forgetting of the maybe several dozen not great results that happen to get the one good result. And so there is a tendency I think to to take people down the path in case they’re the next person who will get a good result.

[00:22:06] And, I think as someone who’s trying to provide healing and to lengthen life, it’s tremendous, that desire is really strong and I think it’s not anything malevolent. by doctors to say, yes, I’ve got another treatment for you, but maybe sometimes it’s not offered in the full understanding of, what that person might want, and perhaps not always offered with the surrounding needs to go with it.

[00:22:34] I don’t want to sell my colleagues short because I, I admire them a lot and they do a tremendously hard job. but I think if the messages are different, or the message to the patient is different from the conversation I have with their treating doctor, that’s where the difficulty is. and so then those conversations become very difficult, I think.

[00:22:55] But in the end, our job is to to do what the patient desires.

[00:23:00] And even if the choice the patient makes is a choice where I might think, oh, that’s a really bad, a bad road you’re going down. If it’s the path they choose, my job is to go there and to support people wherever they go, you know, medically, as long as they get the chance to be fully informed.

[00:23:20] And then, and whatever choice they make is the right choice because it’s their choice. And our job is then to say, we will walk with you, whatever that path is, for better or worse. because you won’t be abandoned, whatever that process might be. It’s really important to know someone is always going to be attentive.

[00:23:38] Maryanne: And I do believe that. I think if given the opportunity to look at the two pathways honestly, I think, that’s the ideal, isn’t it? So that the patient can be informed. Because. You know, from what I know, having worked in this area for a very long time too, is that palliation or palliative is often considered only a part of end of life when it’s not really.

[00:24:01] Ralph: not at all.

[00:24:02] Maryanne: you want to talk to that as well? Because I do think people, yeah, yeah,

[00:24:06] Ralph: think you’re quite right. I think part of the community understanding of palliative care is that, we get engaged with people in the last couple of days or the last couple of weeks of their life, and that’s it. And to be honest, when I started, if we go back a couple of decades, I think that was very much, at the hospital where I work, that was the overall approach. It was almost like, well, you wheel your patient up to the door of the palliative care unit and it’s closed. But after dark, the door opens and someone sneaks out and just brings the trolley inside.

[00:24:39] And then we close the door and you never see that patient again, you know, like Gollum. But, you know, it’s so not like that. But I think that feeling of, oh, the palliative care people come to see me, I’m dying. And all the evidence is, we know patients with hematology, with cancers, carry the same, if not greater burden of physical and emotional distress, as people do with breast cancer or lung cancer or prostate cancer.

[00:25:06] But, The invitation to support those patients often isn’t offered because the perception in hematology very much seems to be, Oh, you’re not palliative yet. You’re not palliative till you can hardly breathe or you can’t open your eyes. You’re so frail and so sick. And sure, That’s part of the process, but we can do a tremendous amount to ease the level of suffering and the burden of distress that’s associated with cancer and its care, months or years in advance of that time.

[00:25:36] And I’m pleased to say, I think there is a change in hematology where I say, look, this person’s got bad pain or they’ve got another issue. Why don’t you come and help us with that? And then. If that’s under control, go away for a while, which is fine by me, you know, and maybe another admission goes by or two and nothing is untoward, and then maybe something else arises that requires expert assistance, we can come back in and provide that care, whether it’s emotional or physical, and then if we’re not needed, we just, you know, recede.

[00:26:08] But there. And so contact with people can be intermittent over the course of some, quite some time. I’ve certainly been engaged with people, say with myeloma, whose first presentation might be a bone fracture, and they’ve got horrible back pain or wherever it might be, and we can help resolve that.

[00:26:26] And then they go on to active treatment, and I might see them periodically 10 years. And just because I’m there doesn’t mean they’re at the end of life. It just means they need expert help with their symptoms. And that’s a big part of what palliative care does. So in many ways, you could call us a supportive oncology service who do end of life care, as well as symptom control over the course of the illness.

[00:26:51] And that’s how I’d put it. be preferred to be seen. If we could change the community perception that we give expert assistance with symptoms and then when it’s appropriate we care for people at the end of life as well. But we can do both those things.

[00:27:05] Maryanne: See, I love that and I love that we’ve brought that to this discussion because it is that perception, Ralph, and I

[00:27:13] love, I love the way that you have explained exactly what your role is and that it is very much about symptom support.

[00:27:22] Ralph: and part of that is helping people think about when they’re ready and when they’re open to the conversation is really thinking about ultimately where is your disease taking you

[00:27:32] and Have you thought about that? Because so many people don’t. And I think it’s so helpful to have a discussion with the people you love in your family early in the course of illness.

[00:27:45] Because some of these things we know are ultimately unfixable. And that life will come to an end because of that condition. Others, you think, if I get a successful transplant, I might live a full life. And you may well. But in that process, it’s thinking ahead. Will I not so much survive the transplantation, but how will I go in the one or two months following that?

[00:28:10] And will it lead to a full life or will I run into trouble and not achieve that? And I think having been open with the people you love and talking about what happens if things go sour, it doesn’t make it happen any quicker. It doesn’t stop you from living. It doesn’t mean you won’t recover. But what it does mean is one of those things that you keep in a corner that you don’t look at is suddenly out in the open and it loses its power over you.

[00:28:40] If you’re able to talk to the people you love and say, I might die. If I’m going to die, how do I want that to be? And how do I want to be with the people I love? And have I done the sort of paperwork that means if I suddenly find I’m dying, and sometimes very sudden with haematology, have I got all my ducks in a row so that the people, when we separate, I don’t leave them with terrible legal wrangles and problems like that.

[00:29:09] And doing those things just makes it so much easier. just so much better for people. So all I would say is don’t be afraid. It doesn’t actually alter anything, except some research tells us you actually might cope better and process what happens better, even if you survive. It takes away this unspoken power of saying, I might die. And if you can take that power away, how much better off are you? you? know, and it means you can cry together, and you can hug each other, and you can talk about the bad things without some saying, oh don’t say that. It’s okay, you know, you’re not going to make a bad thing happen.

[00:29:49] And the worst that will happen is someone will cry for you and someone will tell you they love you.

[00:29:53] And is that bad? You know, that’s part of the richness of, being loved.

[00:29:59] Maryanne: It’s so

[00:29:59] Ralph: take it when you can get it, you know. It’s, it’s nice. So

[00:30:06] don’t be afraid. That’s all I would say about that. it’s not going to alter the outcome. I bet you might cope with the process better.

[00:30:13] Maryanne: Oh, so wise, Ralph. Just so very wise and beautifully articulated. Laughs Ralph, have another question, working in the area that you do in palliative care and, holding the space for many families with, the sadness of, someone’s end of life, from young people through to the elderly and the dynamics of family. How does that impact you as an individual the and your world? it’s very stressful. Very little. Um, and I think in a way you, take as your responsibility the burden of suffering that someone carries. And I find that a heavy burden. and it’s really serious. you can’t stuff it up. have to do a good job. And I find that Very stressful. I think the fact that usually we have a good, you know, those efforts are positive, it comes back to the, I did a good thing that mentioned earlier.

[00:31:15] Ralph: I think I can take that home at the end of that and say, yeah, I did a good thing. I’m okay. I don’t always get to take that home

[00:31:23] And, sometimes it takes a lot to digest what happens. And sometimes the burden of someone’s end of life. stays with you for a very long time

[00:31:35] and you do have to develop a way to just set it to one side a little bit coolty part of that I have a, almost like, sports people have little rituals they do, you know, before they go out and play a game and stuff and I have little things I do for myself at the end of someone’s life that helps me process that and won’t sort of go into what they are but I do have my own. self soothing way of helping myself cope because, it hurts

[00:32:04] nyan, nyan, it doesn’t hurt you, you shouldn’t be in this job. very true. if you don’t put your humanity at the bedside, you aren’t doing your job properly. No at the same time, you have to know not to let yourself get shredded in the process, and I think that’s difficult.

[00:32:23] So having people who understand the burden that you carry as a physician, people, so often another doctor that you can talk with and share those feelings, having a family that cares about you and supports you is a tremendous positive for me. I think over the years you develop a way of just setting things aside.

[00:32:45] But it would be a mistake to think that you go through this without accumulating a degree of weight, a burden that you carry. And that’s the one thing. I mentioned retirement before, but as I’m getting closer, the one thing I’m looking forward to is setting that burden down,

[00:33:03] Ince, I don’t know that you really appreciate how you change as a person over decades of doing this, but I think you do, what you would. I am sort of looking forward to discovering the bloke that was under there Those the outset, you know, because I might have lost a bit of him along the way, so I’d like to discover that bit again, I That, personal reflection. I Willow, So it’s not easy, and you do have to care for yourself. It’s really important, I think, to find other things. Finding balance and putting in place those rituals that mentioned that you do

[00:33:39] Maryanne: do,

[00:33:40] Ralph: are really important

[00:33:41] Maryanne: Yeah,

[00:33:42] Ralph: And, you know, I think there’s other stuff, I like to exercise. I think that’s really helpful. And I like taking photos. So find photography very meditative, and I think I take reasonable ones these days. that’s one of the great pleasures in life, is printing out something you’ve made.

[00:34:00] Maryanne: absolutely. Well, it’s pastime. It’s passion. We all have to have something that we, that, takes us away from,

[00:34:07] Ralph: Yes.

[00:34:07] Maryanne: day to day activities.

[00:34:09] Ralph: And having a bad sense of humor is really important.

[00:34:13] Maryanne: I it’s a good sense of humor. A banter isn’t a

[00:34:15] Ralph: well, yeah, because one of the things I really like is that I can make dying people smile, and I make dying people laugh. and that’s not intent, it’s just part of who I am.

[00:34:27] Speaker 10: Mmm.

[00:34:28] Ralph: know, don’t stop living till you die. And those little moments where you can bring humor into someone’s life and a bit of silliness. It’s tremendously gratifying

[00:34:38] Maryanne: Oh it and quite liberating too, because in those moments, I’m sure that person who is facing their mortality goes, What? Having a giggle.

[00:34:46] Ralph: yep, and they go, not another dad joke, stop, stop, no more dad jokes, but I, I can’t help myself.

[00:34:54] Maryanne: No, that’s lovely Ralph, thank you for sharing.

[00:34:56] Ralph: No worries.

[00:34:57] Maryanne: last question is, is there any advice that, I think you’ve answered it, but you might want to, shape it, uh, is there advice that you would like to share that you feel it is important for us all to consider when we’re supporting our loved ones, have a diagnosis and they’ve been told that no more treatment options, are available?

[00:35:18] Ralph: I mean, it’s a really disappointing and distressing point to come to in the conversation with your treating doctor, really, to find there’s no more active treatment. I think the first thing is that it doesn’t mean there’s nothing more that can be done. It just means there’s nothing more we can do to control the cancer. So doesn’t mean just go home and suffer. So the first part of that is there is always something that can be done. There is always something that can be done. You just need to be connected to the people who can do that with you.

[00:35:56] Maryanne: Yes.

[00:35:57] Ralph: Not to you, with you, right?

[00:35:58] Maryanne: you. And I love that.

[00:36:00] Ralph: think other thing is, if you can, be open to conversation you come to that point.

[00:36:08] Because it’s frightening, and it’s the very thing that you fought against. That whole time that you’ve been receiving treatment, it’s to stave off the end of your life. and if you hear the message, we can no longer hold it back, then I think the best thing is to think, all right, you can’t do that. Can I have some sense of control about what happens to me now?

[00:36:32] Speaker 4: Yes.

[00:36:32] Ralph: comes down to conversation. How do I take charge of what my life might be like now? and I think it’s things like thinking about resuscitation plans and thinking about advanced health directives, all those sort of documents. At their heart, it’s about trying to give you control over what might happen. And so that you can make some And maybe not my best analogy, right, but I often say to patients it’s a bit like planning a home birth. That, you know, if you’re expecting a baby and you think, well none of that hospital stuff, I think I want to have my baby at home. So what you do is you find the people who can support you, inform your family, you gather people together who can provide the best support in that setting.

[00:37:23] And what you hope for as an outcome is a successful birth. so as odd as that sounds, I think planning how your life might end is a bit the same. That you gather the people around you who can help it happen in the way you want. That you bring your family close so that they can provide the support and the happiness.

[00:37:46] that they can deliver to you, and then you go forward in the confidence that I’ve got everything together and maybe I can take control of that circumstance. Now, just like having a baby, you’ve got to have an emergency plan, right, because sometimes babies come up upside down and backwards. And sometimes there’s two and not one.

[00:38:06] And your plan to have your baby at home goes sideways. And sometimes it’s the same when you’re thinking about how do I want my life to end. There’s the desired way, but you need a plan for what happens if that goes sideways. And so that’s an important aspect of it. And I think even if Life doesn’t end at home and often in hematology it ends in hospital. It’s then, well, if it’s going to end in hospital, how do I want that time to be? You know, and I guess the example I always use is of a young lady I looked after probably 10 years ago who, had a breast cancer and she was in her mid to late 20s. And when she realized her death was coming in that last day or two, her family came to the ward where she had chosen to be.

[00:38:52] They suspended gum tree branches and leaves from the ceiling of the room, which was doable. They put fairy lights all through it. They put down, handmade rugs and things on the floor, her friends came and picnicked around the bed and she had two friends who were musicians and they played a cello for the last 48 hours of her life in shifts.

[00:39:14] And it was just a beautiful, gentle way that life ended that said, this is how I do it. This is how I’ve taken charge of the end of my life. Rather than being on a machine in an intensive care unit with bright lights and things going ping and two visitors at a time,

[00:39:34] Maryanne: Very true.

[00:39:35] Ralph: you have the ability to make some plans that let that time be yours.

[00:39:42] I think that’s the good thing about a good Advanced Health Directive is to say this is how I want to do it.

[00:39:49] If you’re Richard Branson, it might be under a palm tree in Tahiti. Most of us don’t get that choice,

[00:39:54] Speaker 3: No, we don’t.

[00:39:56] Ralph: But within, within limits, maybe there’s things that you, can craft to say to your family, this is how I want my life to finish. and this is what I’m going to show my grandchildren. This is what I’m going to show my parents. This is how I want to conduct myself at that time.

[00:40:12] Maryanne: I love that because, I mean, I don’t know whether you’re familiar with the palm, the dash. I think I emailed it through to You

[00:40:18] You that birth date and the day we exit this planet. And we all have one. We all have that little dash in

[00:40:24] Ralph: we do, yeah,

[00:40:25] Maryanne: So what you’ve shared there is very much that. Empowering message around how do you want life to look, you know, informed choices, having the conversation.

[00:40:37] Ralph: yeah, and don’t be afraid, you know, it is scary for people, but nothing bad happens because we talk about it. You get freedom, you get one less anxiety. And you build a relationship with someone who can help you in that setting. Those things are so valuable.

[00:40:55] Maryanne: So valuable, as is the time that we’ve spent here this afternoon.

[00:40:59] It has been rough. I mean to get the opportunity to speak to someone who is as highly respected as yourself, thank you for your time this afternoon.

[00:41:08] Um, and I know that many blood cancer patients who listen to our talk. It’s the third top around the country podcasts him.

[00:41:17] Yes, it is. quite the

[00:41:19] Ralph: yeah, that’s very

[00:41:20] Maryanne: You need to get listening.

[00:41:21] Ralph: I do. I’ll have to look at that in my retirement.

[00:41:24] Maryanne: exactly, exactly. But no thank you Ralph. Is there anything else that you feel is poignant or

[00:41:32] Ralph: No, I think, just don’t be afraid of my specialty.

[00:41:36] You know,

[00:41:37] we’re nice people.

[00:41:38] Maryanne: yes, oh absolutely.

[00:41:41] Ralph: yeah, and we don’t want to tell you what you’ve got to do. We don’t want to make you do things. We just want to be led by your wishes. And we will get you where you want to go, as long as it’s realistic.

[00:41:52] Maryanne: very comforting words. Thank you.

[00:41:56] Ralph: No worries.