Relieve pain and other severe symptoms. Together with the nurse, bandage patients with extensive wounds, talk, explain, calm down, inspire hope Every day, the head of the palliative care department of the city hospital 30 in Nizhny Novgorod, the third-generation doctor Elena Stanislavovna Vvedenskaya has to solve many different problems, and not only purely medical … After all, palliative medicine is, first of all, humanity. You cannot cure, but you can support Elena Stanislavovna comes to work at 7.30 am and leaves at 6-7 pm. There are 35 beds in the department, you have to see each patient, go into the ward more than once or twice. Such patients are usually not admitted to other hospitals. Someone has severe anemia and needs to raise hemoglobin or platelet counts to continue chemotherapy. Someone is worried about persistent nausea and vomiting after chemotherapy. Or the indicators characterizing the work of the liver and kidneys are off scale, and such weakness that it is difficult to get out of bed. Severe pain, which was not handled in the clinic. “Sometimes we do the most serious patients for half a day,” she explains. - I call consultants, together with them we make decisions. I consult doctors on the phone on pain relief issues, I consult a nurse and a paramedic who went home, I go home to patients myself. I talk with my relatives. What for? So that people understand what is happening, what are our tasks and opportunities, what we can achieve with therapy. Elena Stanislavovna has been working in this palliative department since 2018, but she was at the very origins of the organization of this type of medical care in Russia. No wonder, announcing her report at one of the all-Russian conferences, the chairman of the board of the Russian Association of Palliative Medicine Professor Georgy Novikov called Vvedenskaya a legend of Russian palliative medicine. Elena Stanislavovna is the main organizer of the first Nizhny Novgorod hospice, created 12 years ago. And in 2006, together with a programmer student, she created the first informational Internet resource on palliative care in Russia. “The palliative care unit is not a hospice or a nursing unit,” explains Elena Stanislavovna. - Yes, leaving plays a huge role in our work. But we do more than just feed and change diapers. Our department is located in the structure of a multidisciplinary hospital. It couldn't be otherwise. We have a doctor-anesthesiologist-resuscitator, urologist and surgeon, they carry out the necessary medical procedures. We painstakingly select anesthetic therapy. If the patient cannot breathe on his own, he is connected to a ventilator, and the ventilation mode is selected. Then the patient with the device can be discharged home. We assign examinations, find out what is the reason for this or that condition, think, make decisions, send for consultations. The palliative care unit is not a place to be brought to die. The atmosphere of kindness The department is warm, light, very clean, the employees smile, talk kindly with all the patients. It is immediately felt that you are in a special atmosphere of kindness and warmth. The staff here is very good and is with the patients almost all the time. In one of the wards - a young man of 35 years old, was admitted to treat deep and large bedsores. Absolutely immobilized: arms and legs do not feel anything and do not move, the pelvic organs do not function. Last August, he stumbled while swimming on the beach and fell into the river, breaking two cervical vertebrae. At the same time, the man has a clear mind, speech is normal. Neurosurgeons operated on and passed a verdict: only palliative care is indicated. - He realizes that all his life he will have to lie in complete immobility, - says Elena Stanislavovna. - In deep depression, mental pain feels like physical. Our clinical psychologist Oksana Valentinovna works with him. In the morning she goes around all the wards, knows the history of the life and illness of each patient, what worries him, what he is worried about. Provides psychological support to relatives. It is important that palliative care also indirectly improves the quality of life of close patients, who often do not know how to support a loved one. “Recently, a 35-year-old woman with a large tumor in the pelvic cavity was lying in the ward,” continues Elena Stanislavovna. - Clamping of the ureters, stenting of the ureter, stoma of the kidney. Edema of both legs is very pronounced, severe pain. We assess the situation comprehensively and decide who can be with her in recent days. It turns out that her mother did not know that her daughter had cancer and that she had undergone chemotherapy: her daughter did not want to upset her. We contacted relatives, my mother, invited her here. A mother needs to know what is happening to her child. Laws of the Universe It is help to relatives that underlies the development of the visiting patronage service, created by Elena Stanislavovna. Service is especially in demand during a covid pandemic, when people are afraid to go to the hospital because of the risk of infection. In the first wave, the department was generally closed along with the entire hospital for a covid hospital, and only an outreach service worked. For example, specialists go to dressings - cancer patients have very complex non-healing wounds, huge, with decay, bleeding, relatives themselves cannot cope. - Why does oncological disease arise is a difficult question, unresolved, - reflects our interlocutor. - I believe in fate, in the laws of the universe. The more you work, the more you realize that everyone has their own path. To some extent, it is predetermined, but it is also important what deeds a person does, how he lives. You need to move more, smile more, do good deeds. If you do not do bad to anyone, evil will not return to you. This is the law of the universe. Don't worry, but act. Burnout is an important topic in palliative care. This is when there is no strength. They are over. The consequence of this is fatigue, bad mood, unwillingness to go to work. “After 40 years, I have developed a protective mechanism,” admits Elena Stanislavovna. - I do not take on someone else's disease in 80–90% - I act. This is the reaction of a detached attitude to the situation. But this does not always work out. There are patients who are very young, or those you like, or in some way similar to you - and then it is very difficult to experience someone else's pain. But I always remember how the founder, Vera Vasilievna Millionshchikova, spoke about the philosophy of hospice: “If you die with every patient, you will not be left for others.” The second important point for preventing burnout is a favorable healthy psychological climate in the team. If there is a problem in the department, we solve everything together: doctor, nurse, nurse, psychologist. And everyone knows what he has to do at the moment. You need to constantly communicate with people - in a kind, human way. Explain, show, do it yourself, ask, support, comfort, encourage, praise. Our team is one big family. It is our life. I can come to work on weekends. On New Year's holidays, we, doctors, just worked every other day, taking turns. And I'm constantly on the phone. I call the department in the evenings, on weekends to ask how you are doing. Probably, it helps that Elena Stanislavovna grew up in a medical family. Her mom and dad are also doctors, professors, for a long time they headed departments at the medical academy. Grandfather and grandmother were doctors. Brother, uncle and aunt, cousin and husband work as doctors. And her husband is also a doctor - surgeon. Only my son did not go into medicine. - What does my husband say about my work? - Elena Stanislavovna ponders. - He is offended that I am not at home much, but he understands. It is restored in nature. In the spring, summer and autumn on weekends he is engaged in gardening and gardening. In winter, when invited to visit a country house, he loves to clean the snow. I used part of my vacation before the pandemic to participate in conferences on palliative medicine - I gave lectures, listened to speeches. He says it's never too late to learn. She did not regret her professional choice for a minute. “I love my job, this is my life,” admits Elena Vvedenskaya. - I like to help, seek and find solutions, communicate with colleagues. And when you understand that you did everything you could, and the person felt at least a little easier, he smiled or understood something important - I feel satisfaction from my work. This is the most important thing for which I work.
