A right to die

Do you think you have the right die?
What is your answer instinctively?


I guess many will be, 'yes'.
However, in the UK you do not have a right to die unless you commit suicide.
The states has a duty of care to care for you medically as well as social care,
housing, and social security. I also remember a case in which the man was so
hopeless (no mental health issues) and wished no die, but I had to support him
in various ways to 'sustain' his life. He did pass way with natural cause few month later.

There has been in very interesting case at the High Court about the very
subject and I was interested if the UK law is ready for one's right to die.
Below is a link to the man who took the case up to High Court to meet his needs,
however he failed and he passed away only few days after the ruling.

Tony Nicklinson

If the case had won, it would have had a hugh impact in many different levels within
individuals, society, law, medicine, and social care. First of all, it is a moral question
for all of us to think about.....

Further reading;

http://www.bbc.co.uk/news/uk-england-19341722

Good byes.....

I have decided to go on a secondment to Reablement Team
which is a short-term assessment team at the end of the month.
Therefore, I have been busy closing all my cases and I have visited
a number service users to say good bye and to inform them I will
be de-allocated from the case or re-allocation of cases to other social worker.

One of my long-term MND service user was in tear when shared
my leaving news. She has always been very warm and nice.
She has never let a Christmas go without a small gift.

I will really miss my old team, but I need a small change to keep me sane!

Risk Assessment

A very good training on Risk Asssessment, mainly in mental health,
however still relevant to my post for dual diagnosis cases.

A difficult conversation...

I wrote about a cancer service user previously.
She and her partner are not the easiest people to engage with
but they are so funny and warm when you get to know them better.

Palliative Care Team is involved but the couple is new to them and the
social worker who was going to support her with writing a will
came back to me for help. So I went to help her filing out the
will booklet to be sent to the solicitor. I left it with her two weeks
ago but there were areas she has not decided on yet e.g executor etc.
The important parts of the will required more decisions to be made.

She become tearful a few times and diverted the conversation to another
subject and I had to make her focus on a number of occasions.
I said to her that it is a difficult conversation and she is
welcome to take her time to think about her will.
On reflection, did I really want to arrange another visit to gather more information?
Not really, I was actually quite keen to complete it today and post it to the solicitor.
          A, I did not want to delay the process
          B, Tight with time to visit again.

I agreed to return next week so that she has enough time to think about
the detailed information. I knew that it was not going to be finished in one visit
and End of Life Care work does require more time and patience. Although,
in practice, I realised I was rushing myself to gather the relevant information.
It is painful enough for her to face her own death and to be making plans for
after death would have been more difficult. I am honoured to stay with
her through the journey for the next few months.

If I were to remain in practice for longer, palliative care social work would
have definitely been my next move.

what matters to you

'Our live begin to end the day we become
silent about things that matter.'

-Martin Luther King Jr-


It is really true when you think about it.
The quote was used as an opening at the End of Life Care training.
As many societies fear to discuss death although it is a
natural process for all of us. If we could re-think about death
by promoting 'good death', which could be an empowering experience.
Think about what 'good death' means to you.



.

Gut Feelings

'Gut feelings' are informal judgement tools in many ways.
I often hear other social workers say, 'Looks prefect on the assessments
but my gut tells me otherwise.'

I had a feeling yesterday that a client may have passed away.
It is a case I talked about last month about the carer's funding.
I was going to email the provider today rather than the wife as
my involvement has ended and I would not have to make such contact.
I received an email about lunch time from the provider informing me
that he had passed away yesterday. How strange!
This is my second case that I had this feeling of know someone's death.
I felt my grandmother's death too actually.

May he rest in peace............

It does make me scared at times when it is this accurate.
However, my gut feelings can sometimes be so wrong in my personal life.

You have 1 month....

I had a couple of new cases allocated today.
One was one of my ex-service user who I worked with
for over one year, a pretty chaotic case...
alcohol misuse, financial abuse, constant falls, difficult partner etc

I heard about her cancer diagnosis few months ago
and I remember posting about cancer cases last year.
Her prognosis is so poor...1 month...lung cancer can develop
so quickly and the pain is unbearable. It is quite sad to see
someone die slowly but I always advocate for a good death
and I will try to assist her for a comfortable death.

Yes, a good death will be a very relative concept but I try to
deliver is a good death by fulfilling ones wish of the place
of death e.g. home, hospital. You will be surprise to know
that majority of people die in hospital which is often against
their wishes.

Carer's funding

I had a case who has an aggressive brain turmor
making good progress but it took a turn over
Christmas. He was then admitted to a hospice and
he is now palliative and his funding has also
been transferred to NHS. I will exlpain this aspect
later about the two different channels of funding- NHS & Social Services

The interesting bit was were the funding for his wife,
his informal carer, comes from when the cared for is
funded through health. I did not have enough time
to look up the legislations but the managers said it is a very
grey area. You would think it will also be funded by health
but it is the local authorities assessing the carer's needs
and also assisting with provision of carers' services, that is where
the complication lays in cases like above. I still do not have the answer....

Loss in Emotions

I have only managed to come back to my own case work
yesterday after 3 days full duty and a sick leave since
coming back from Christmas leave.

It is not clear whether I had a good time off that I have
loss tract with my cases or I have lost interest in work.
I think it will be bit of both as I really struggle to go to work
today. It is not about having interesting cases to work with.
I have enough complex cases to work on that are demanding.

I had a late visit at one of my MDN service user who is
always a delight to see. She also gave me a small Christmas gift,
a bottle of Baileys. She never forgets it, this is my second one,
I hope to get it year after years....what I am trying to say is that
I am not sure how long she will be healthy for.
I always take a deep breath whenever I receive a call in relations to
MND service users as it could be a surprise news.
However, I must say I somewhat did not have much emotional
strenght to be present with her. I hate this feeling of being so
detached from what I do. I know I cannot always be emotionally
charged as I am a human being but I felt so distant.....


.

Oh...... Dear......

I am a bit early for a meeting.
It is good that I am not in the office this afternoon
as I had such a stressful morning that I could have
lost myself. Well, I nearly did loss myself on the telephone
with a wife of a client.

Yes, it is one of those days but I just feel more and more
that I am not coping and is it worth just pushing
myself to try and work if maybe I cannot deal with
certain aspect of some people.
It has been a question that I have been asking
myself over and over again.... Am I fit for the job?

..........2012

We are trying to go paperless but we are not there yet
so we still have the luxury of keeping a paper diary.
I use the outlook calendar too for easy acces for other
team members. I was given a 2012 diary and it feels
quite scary to know that 2011 is coming to an end so soon!!!

Absent Minded

I have been on duty for the last three days which have been so hectic!
I am so pleased my three days slot is over for this year and just odd
days here and there till mid December.

I had nearly 20 cases to work on but managed to get down to 4 cases today,
I hope my next duty social worker will be happy to have a small pile of files.
It has been a challenge as my team is the pilot to go paperless when the system
is not fully set up to support us just yet! But it was ok to manage duty.
I just had to concentrate and not loose the chain of thoughts on one case when
telephone calls were transferred half way through a case.

However, I am not sure how many letters I wrote today, quite a few, and the
team admin worker asked who wrote a letter without writing an address on the
envelope at around 16.45 and I just happend to pass by and said we will have to
open and have a look. Well....yes... you might have guessed!
It was one of my letters!!!! We stood by the cabinets laughing so hard.
This shows how busy I was on duty, but it is over and I should get on with my
own cases tomorrow...so many emails to follow up though I have followed up half
of them whilst I was on an hour lunch breaks, I work through my lunch most of the days.

Just one more day and the weekend! Nearly there!!!

Old & New

I have been allocated a case, that I worked
with more than a year ago, for a review.
This does not happen often but it makes it
easier as I already know my service user
and the family.

The husband said it was nice to know
that I am allocated again. It was a nice
feeling to be appreciated at times of what
you have done for them. I must have done
something right!

She has deterioriated and now has
a feeding tube, PEG, in situ.
Well, MS.... It is a progressive neurological
condition so I will just have to see
how it develops and assist when required.

Another loss....

What a week!
First news I had this morning as I walked into the office,
a note on my desk stating a death of a service user.....yesterday afternoon.
This is my second deceased notificiation this week.

One was a cancer service user
and the other was a motor neurone disease service user.
I worked with the latter service user for nearly 2 years and there was
a lot of work required at the beginning. She had 24 hours care at home in the end.
I did not feel ready to ring her son today, but will drop him a call early
next week. I bought a card to send to the family signed by
all the professionals who worked with her, an occupational therapist,
a physiotherapist and palliative care team.
I little warm touch won't be too unprofessional I guess.

I heard about the death of my close friend's father after a bitter battle with cancer
at the weekend too. I was not surprised as his cancer was at such an advance stage.
Whatever the reason, loss of a love one is a really sad news....

May everyone rest in peace.........

Intuition

I was allocated a cancer service user in September.
My gut feelings were telling me that we might have lost her.....I do not know why....

She was suffering from an advance stage of ovarian cancer
who was waiting for a major surgery. I followed up to the point
that her surgery was a few days delayed and requested the palliative
care nurse to contact me for discharge plans. I contacted the nurse twice and
left messages and sent emails for an update but did not receive any form of
contacts from the nurse.

I picked up the phone and dialed the service user's mobile number then had a feeling
that this was a wrong move. So I rang the GP instead and I was informed
that she has passed away two weeks ago....as I thought.
I was glad that I did not ring her phone or any of the family members as I have not met
them and it would have been so distressing for them if I had rang to arrange a visit
when the person has passed away.

How interesting that I had the feeling that she might have passed away?
Yes, I think you need sharp observation skills, a cold head, a warm heart and
the ability to trust your intuitions as a social worker.

May she rest in peace.....

Volumetric exercise

Is that going to justify what I do on a daily basis?
I, we, was given an excel spreadsheet will lots of colums and drop down options
to select what I do for this whole week. I did it for today and I must say it was rather
irritating to clink to the rigid options to fit into what I do
e.g. number, nature and length of telephone calls, case discussions, report writing etc.
....and I do tasks that were outside the given options.

Why?
The re-structuring has started and the council is trying to get their heads
around on the number of social workers required for adult services.
As we are moving to the new office space around summer next year to
quite south of the borough and the ulitmate reason, cost savings to be made!
I know some boroughs have started the re-structuring sooner than us and
mistakes were made in terms of dismantling the specialist teams, like mine.
I hope lessons are learnt to keep it but we will have to see what happens after
this volumetric exercise has been analysed. I am sure the number will be reduced.
Watch the space!

Mental health tribunal

I was granted what i went for.
A little too drunk to write about it now.
Will follow up soon

Guardianship Report

Mental Health Tribunal has been arranged for this Friday
which is not my preferred day as I have not completed the
Guardianship report yet but one of the tribunal panel member
could only attend on the 14th so I had to re-arrange my diary.
I am applying for a Guardianship under the Mental Health Act 1983.

Work at present is pretty busy and this piece of work is an
additional to what I have already so finding time to complete this
long report has been a fight. Furthermore, the panel requiring to
see the report prior to Friday has really pushed for time.
So here I am nearly 12pm today working at home after a long day
as I want to pass the report to the senior who is overseeing the work
first thing in the morning for him to add his part. It is not my direct manager
but a different manager who is a specialist in mental health assessments.

I have not brought work home for a long time but sometimes it is just
inevitable, but should not really do it though. I have to say despite the
pressure, I did enjoy writing the report bring my memories back from
my training time at Goldsmiths College. Also, I am looking forward to
presenting the case at the Tribunal with the manager on Friday as
it would be a new experience. I hope I do not get grilled too heavily!

Glasgow Reviews

Never started work this early!
Woke up at 6am to catch the 7.30am train to glasgow.

I had to visit two service users in a residential home to review
how they are at the placements.
Two quite interesting people, 1 hour delay was
all worthwhile!

Isn't this interesting and quite caring?

 

Will write more when I return home.
I'm staying the weekend in Scotland, Edindburgh tonight and not sure tomorrow, I will see where the wind takes me. Will think about it tomorrow.
Let me check out the night life in Edinburgh!

Guardianship

I have an interesting assessment to complete tomorrow at Mildmay Hospital,
a HIV specalist hospital (not under NHS, a voluntary hospital).
Yes, a man who suffers from HIV and HIV related dementia.
It will be Guardianship, Section 7 under the Mental Health Act 1983.

I have got some reading to do but I'm procrastinating.....
I should get on with it as I had a lovely weekend with much fun!


Guardianship- (reference- Alzhemier Society Website)
A guardian can be appointed with limited powers to take decisions on a person's behalf under sections 7-10 of the Mental Health Act. These decisions must be made in the person's best interests.

Guardianship can be arranged if an Approved Mental Health Practitioner or the person's nearest relative applies for it, and if two doctors agree to it.

In most cases the local authority is named as the guardian, although alternatively, a friend or relative may be appointed. A guardianship order cannot proceed if the nearest relative objects to it unless their powers are transferred to someone else.

A guardian has the authority to make sure that:
•the person lives at a specified place.

•the person goes to the place where they are required to live if they do not (or cannot) go there without assistance.

•the person attends specified places for medical treatment, occupation, education or training.

•access be given to the person by a doctor, Approved Mental Health Practitioner (AMHP) or other specified person.

The guardian cannot authorise medical treatment, and has no control over a person's money or property. It is an offence to mistreat or wilfully neglect a person subject to a guardianship order. A guardianship order initially lasts for six months and can be renewed for a further six months and then annually.