Death - an unpleasant topic for many. Senior physician Philipp von Trott knows from his everyday life that on a palliative care not only medical qualities are in demand: "Several times I have seen a wife say to me: 'I know, I will die, but do not tell it to my husband. 'The husband then said,' I know she's going to die, but do not tell my wife - she does not know about it. '"
Trott's palliative doctor, who works at the Gemeinschaftskrankenhaus Havelhöhe in Berlin, then arranges an open discussion with the two. The relief after the exchange is usually indescribable.
"The best possible quality of life for as long as possible"
Palliative wards in clinics are often misunderstood. This is where people with a disease that is no longer curable can get there. However, that does not mean that death is imminent. "Our job is to make sure that patients have the best possible quality of life for as long as possible," explains von Trott.
The patients, who are mostly suffering from cancer, spend an average of nine days on the ward. There it is considered: Is further chemotherapy useful? How do you keep the pain small? What does the person in question wish for the future? What needs to be clarified organizationally?
An interdisciplinary team of doctors, therapists, caregivers, social workers and volunteers takes care of these concerns. It is not primarily about the disease, but about the healthy in man, the resources. If the maximum mobilized, it goes back home. Not infrequently for years - if the patient comes early enough. But that's exactly where the problem lies.
"Palliative care unites many with a terminus," says von Trott, "if I go there once, I'll never leave it again." As a result, patients turn to palliative care or specialist physicians much too late. And that in turn means more people are actually dying in the hospital than it should be. Because: Most people want to die at home. In reality, the last station is usually home, hospital or hospice.
Supplied at home
Palliative care is often very well possible at home. Mobile teams come to the bedside, help with complaints, treat pain and take care of the family. "Our job is also to look after the relatives," says Alexandra Scherg from the University Hospital Düsseldorf. "To tell them that they can go out for a change, that they have to take care of themselves." The doctor teaches medicine students in palliative medicine in Düsseldorf.
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Those who do not need close medical care but still need specialized care can also be well looked after in the hospice. "Hospitals take on patients who have a limited life expectancy of a few months," explains Scherg. There you are not alone, there is always someone there. In addition, the facilities relieve relatives.
"If a child is in the household of the seriously ill, many ask themselves the question of whether it is reasonable to die at home," says Scherg. Then a hospice can be a very good solution. This may also be the case if the health deteriorates rapidly and it can be poorly treated at home. Or if there are no more relatives.
How should the last time be used?
"Dying is a process," describes von Trott. Even with a lot of experience and the diagnosis, it is difficult to give a concrete prognosis for life expectancy. Nevertheless, it is important to answer the questions of patients and relatives as openly and honestly as possible and to be available for conversations about existential topics. How should the last time be used?
Sometimes last wishes play a big role. "We have already brought horses to the clinic park," says Scherg. Not infrequently, dying people literally wait to experience a certain thing again and then find their last rest.
If the wish can not come to the hospital, sometimes comes the Wünschewagen: Specially equipped transporters and volunteers of the Arbeiter-Samariter-Bund (ASB) bring the sick to where they really want to be again, whether to the sea or to a concert. Even relatives can request, the wishes are implemented purely by donations. The response is huge.
The last breaths
At some point he came but the last day: When the dying man makes the last breath, the palliative care is again about the dying and his relatives alike. "Not every death is beautiful, you have to say that very clearly," says Scherg.
Medically it is made as easy as possible. It can often be seen from the heartbeat and respiration that the dying person perceives emotional assistance. Just sit next to it and radiate peace that works. Equally important, however, is that relatives do not overuse themselves.
Dealing with suffering is different. Von Trott has experienced many things from mute sadness to loud, collective screaming in the family circle. It's all human, he says. It is important that time is left for farewell and the deceased a last honor.
In the anthroposophically guided Havelhöhe this means about rubbing the corpse with rose oil, the proper beds of the deceased and the opening of the window.