Deciding where Jenny Kwakwa’s day starts and ends is almost impossible. The palliative care nurse at Cayman Islands Hospice Care is on call 24/7, so patients can always reach her.
On a day that was more typical than unusual, she took a call at 3.40am from a patient who was having difficulty with a tube. This came after she had finished up a 14-hour day visiting patients.
‘If the last patient’s family I visited that day hadn’t offered me food, I wouldn’t have eaten,’ Ms Kwakwa said.
Not that she’s complaining.
With her background in psychology and counselling, she is well-prepared for her work at the hospice.
‘Palliative care is not curative. It is about making the most of the life that is left.
‘We are helping people to live with cancer rather than die with cancer,’ Ms Kwakwa explained.
She recently invited the Caymanian Compass to join her for a day in the life of a hospice nurse.
8.30am
The day begins by ringing a patient to check up on him as well as sorting out an appointment with a doctor to discuss the treatment of two different people.
‘I tend to speak to a doctor at least once a day. I have 21 patients who are on about 15 medications each,’ Ms Kwakwa said.
Next stop was a home visit in Newlands and then dropping by the hospice off Crewe Rd to catch up on writing notes on patients.
‘I also received a call from a patient’s relative offering feedback on a suggestion for a treatment that worked,’ she said.
More paperwork followed, and then she was out on the road again.
10.30am
Ms Kwakwa drops by the Cayman Islands Hospital. The hospice and the hospital work together with the patients, she explained.
She checks in at the pharmacy to talk to Jane Burton, the clinical pharmacist at the hospital.
‘We’re very lucky. The pharmacy staff at the hospital works very closely with us, they are very supportive. They are open every day through the evening. They do everything they can to make it easier for us,’ Ms Kwakwa said.
Next stop is the chemotherapy unit, to confer with nurse Cyndy Ebanks.
When the two women discuss their cancer patients, it is almost as if they are talking about family members. It is clear they get to know each person well.
Ms Kwakwa and Ms Ebanks talk about treatments and drugs, any new admissions, and which patients want hospice care.
An oncology clinic is held monthly, at which time both hospice nurses will come in to meet new people as well as discuss the personal situation of patients. It is held over two days. The nurses make sure to look beyond the disease to the person.
‘If patients get to know us in the hospital, there’s continuity then,’ Ms Kwakwa said.
10.50am
Armed with a trunk stocked with dressings, creams, bandages and whatever else may come in handy for taking care of her patients, Ms Kwakwa sets out for Bodden Town.
On the way, she chats about ways to help her patients, a subject on which she is passionate.
One particular problem that cancer patients face is the need for medication, usually administered by injection. An alternative is the battery-operated syringe driver.
‘This provides constant medication over 24 hours. It is gentle and the patients don’t feel it. And they are not in pain from the cancer because it provides a constant supply of medication to manage the symptoms.
‘In England, a hospice will have about 40 of these. We have two and need two more. People can go out or work with the syringe driver.
‘One woman with cancer in the UK used the syringe driver to help with her nausea and she was able to go out for dinner with friends. It allows you to have a normal life,’ she said.
11.10 am
Ms Kwakwa arrives at the home of Leonard Owens Jones, 50, who is suffering from throat and neck cancer. Actually, he lives in a room in a house shared with many others.
When she walks in he is sitting on his bed in front of a floor fan, in a bare room where the main piece of furniture is a table covered with all sorts of medical paraphernalia.
Despite the circumstances, he lights up when she calls hello and is obviously happy to see the nurse. She responds in kind.
Ms Kwakwa helps him manage his trachiostomy tape, takes his blood pressure and checks that he is taking his medication. Her visits are important to Mr. Jones.
‘It means a lot because I’m incapacitated. I only have the use of one hand,’ he said.
Mr. Jones manages to maintain his sense of humour, though. When asked about Ms Kwakwa’s visit, he said, ‘From the mere fact she’s a woman, I don’t mind.’
Since he is on his own, knowing Ms Kwakwa is always accessible makes a big difference.
‘It’s a great help. She is only a phone call away. I call her when it’s absolutely necessary,’ Mr. Jones said.
12pm
Underscoring the relationship between the hospice and the social welfare of patients, Ms Kwakwa stops by the Bodden Town district office of the Department of Children and Family Services. She is there to discuss the help available for some of her patients.
A department worker outlined the support offered. ‘We do all the services available through Children and Family Services such as food vouchers and financial assistance if a client doesn’t have a social worker,’ she said.
Ms Kwakwa clearly considers herself part-social worker and tries to keep track of all of her patients’ needs.
‘I will organise family meetings if situations change so I can talk to all of them at once,’ she said.
12.30pm
En route to her next home visit, Ms Kwakwa stops to ring the patient’s doctor first. The conversation centres on how best she can help him.
The man, who suffers from prostate cancer, is having trouble with one of his legs. Ms Kwakwa checks him and goes through his medications, chatting with him and asking how he feels. She lets him know she will return in the evening to deliver medication for his leg.
12.50pm
She calls one of the care givers at the hospice, to liaise about patients and keep up with things.
1pm
She stops by the home of a woman whose husband of more than 50 years died about six months ago.
Her connection with the family doesn’t end even if the patient is no longer under the care of the hospice.
The hospice looked after the husband through his illness and now Ms Kwakwa visits his widow to make sure she is doing all right. She needs to be able to offer advice on dealing with a different kind of hurt than one that is disease-related.
‘Many patients are uncomplaining and don’t realise that many times there are medications and other things that can help with both emotional and physical pain,’ she said.
1.15pm
Ms Kwakwa calls palliative care nurse Heather Huizinga as the two stay in touch throughout the day.
‘Working with Heather has been wonderful,’ she said, adding that they keep each other up-to-date on the families and help one another through the whole process, which can be difficult.
The nature of the job creates strong bonds with the patients, many of whom will eventually lose their battle with disease.
‘We get to know the patients very well. It is hard at the end since we have become friends. We counsel each other,’ she said.
Though each day is different, she aims to make lunch a constant. ‘We try not to have lunch on the go. It is important to sit down with each other and talk things through,’ Ms Kwakwa said.
2pm
She manages to take lunch in the office, but this time the other nurses can’t be there. In between bites, she writes up her notes for the day so far and talks about her job.
‘We have a 37 ½-hour week, with Saturday and Sunday off, but that never happens. If someone has a syringe installed, for example, we need to supply medicine every day.
‘Nothing is ordered in this life, you need constant flexibility. We pick up all patients who are referred to us. We never turn anyone down, even if we have to work overtime,’ she said.
2.30pm
She is on the phone again, calling patients and their families.
‘There is a fear surrounding cancer and as the family crowds around, the normality of living gets lost. I’d like to think we don’t go in just disease-focused.
‘My biggest compliment this week came after visiting one patient. We didn’t talk about illness, we talked about other stuff and laughed. Her son told me, ‘Every time you leave my mother, she’s happier.’
‘We centre on the patients: what they want, what they need. It is surprising how much control patients lose. We try to restore some of that.
‘We also teach the family how to care for the patient. Sometimes the family teaches us, like about local remedies and salves. There is lots of learning going on both ways.’
4.15pm
She gets ready to leave the office, though her day is not over. There will be more phone calls and that second trip to deliver medication to her patient.
‘This is only the second time since I started this job that I have left this early.
‘But this isn’t like a job; it’s more like a way of life.’
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