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To have and to hold: In conversation with a consultant in palliative care

Last Updated on : 6th June 2019

Managing editor Charlotte Peterson talks to Dr Sam Lund, a fellow local mum who oversees Trinity’s medical care.

Fresh from a meeting with an outpatient downstairs, Dr Sam Lund, Medical Director of Royal Trinity Hospice walked into her office at the top of the stunning Georgian building overlooking Clapham Common and greeted me warmly. She is the epitome of calm happiness, approachability and quiet confidence, and immediately I knew why she does the job she does and holds the position she holds. Families must feel in incredibly safe hands with her at the medical helm of the hospice, which not only focuses on end of life care but also on ‘living every moment’.

Sam first came to Trinity early on in her career as a junior trainee doctor, just one part of her broader training in medicine, and enjoyed it so much that she knew one day she would like to return. Ten years ago she was back to take up a senior position; four years ago she was appointed Medical Director. As a local mum of two (very local, her commute to work is 6 minutes on foot), the full-time role is both challenging and rewarding. “I just love living around here, it’s a really wonderful place to bring up a family,” she said, glancing towards the open window, big skies and horse chestnuts on the perimeter of the common, just steps away.

What was it about palliative care that drew Sam into this specialism? “It was one patient,” she said emphatically. “Life was extremely busy as a junior doctor and I was working on various placements in London hospitals including St George’s and Chelsea & Westminster. It was while I was a Senior House Office in A&E at the Royal London that I treated a woman who had come in with shortness of breath that had suddenly got much worse. We carried out various tests and sadly discovered that she had metastatic cancer. The situation was very distressing for her and I needed to undertake a procedure to remove a filter that we’d inserted during the tests. She was very, very frightened,” said Sam, obviously still moved by the experience.

“By this point, we had transferred her to the palliative team and one of the nurses asked me why it needed to be taken out; now that she was under palliative care, there was no need to remove it. I realised that I’d just been so busy with every patient I dealt with, that I hadn’t actually stopped to question whether I needed to do that procedure now that we knew the prognosis.”

It was then that Sam realised she wanted to do a job where she would be able to focus on thinking much more about exactly what each person needed, to have time to create an individual care plan and make that person comfortable for the rest of their life. So, what of life working at Trinity? “It’s simply a great place with fantastic, supportive teams who work extremely well together.”

Many of us are very familiar with it, but not all of us know how Trinity is funded. One-third of the funding comes from the NHS, but all the rest is generated through tireless fundraising; this year’s target is an extraordinary £10.5m. Sam acknowledges, as a local as well as an involved doctor, that they have great support from those people in the community who know about Trinity – the latest Wandsworth Friends of Royal Trinity Hospice Summer Garden Party held annually in the stunning gardens has just raised an amazing £86,000- but there are many who don’t know and they want to get the word out.

Trinity is open to anyone within the boundaries of its catchment and that is wider than you might think, covering several boroughs and hundreds of thousands of Londoners.

People are often surprised to discover that there are only 28 beds on the ward, but at any one time, Trinity’s teams are supporting around 700 people in the community as outpatients, with everything from home visits led by clinical nurse specialists– who call on Sam and her team when necessary – to outpatient art classes, music recitals, counselling sessions,physiotherapy and even hairdressing. So Trinity offers a thriving community focused on the wellbeing and needs of the patients and their families. “We are here for everybody,” emphasises Sam. “For anyone living with a life limiting illness – it’s not just about end of life care. We are at the heart of the community and the patient is at the heart of all we do, but we’re also here to support the family and friends around each patient too.”

Kaleidoscope is a new initiative set up to support children of patients at Trinity, aimed at providing bereaved children with a toolkit to help them cope with the grief of losing a parent, helping them explore their feelings and work towards an understanding of what has happened. “The first programme recently was a huge success,” beamed Sam. “We had a group of children meeting at the same time as a group of adults, but they were separate so children spoke to children and adults to adults. They’ve already made plans to meet again outside of the hospice, creating a new support network for those children and families – exactly what we wanted.”

“Our door is always open at Trinity,” adds Sam. “We love people to get in touch and ask us any questions they may have, whether that’s to do with the possible care of a family member, those experiencing a bereavement, or simply how they could help us with fundraising and spreading the word.”

And the fundraising takes many forms, whether jumping out of plane for a skydive, running the London Marathon or the Royal Parks Half, knitting and selling the wonderful Easter chicks (perfect size for concealing a Creme Egg) or holding a cake or a bric-a-brac sale, and everyone can get involved. “As well as the medical side of my job, I also enjoy going to talk to people about what we do, to convey the message that Trinity is a place for the community, here to support everybody, and that we will all die. Let’s talk about it, not avoid it. You’re only going to die once, so we’re here to help you do it well.”

Interestingly, Sam says that children are an extremely receptive audience because they often think about death and dying in a very different way to adults. “Sometimes I can be caught off guard and I’m left thinking, what a great way to think about it, or how refreshing to have that approach. I think we can all be overly cautious talking to children about death, and the more open we can be with them, the better it will be for all of us in the longer term.”

Back to caring for the patients and Trinity’s motto of ‘living every moment’ is at the heart of everything they do. “A patient’s care and treatment is all about flexibility – what’s important to you. We recognise that time is short but we don’t focus on that. We focus on what each person wants.” Sam cites examples of patients getting married at Trinity, of going to a concert, to art exhibitions, even up for a longed-for ride in a helicopter. “We try to make these things a reality for patients and a nurse will accompany them if necessary.”

There are no visiting hours on the ward, family members can sleep in the room if they would like to and they have access to the wonderful gardens. “One patient wanted to die under a favourite tree and that is what happened.”

The average length of stay is 17 days; some will be shorter, some will be longer. “We address the patient’s needs; for some that will be to sort out their medication and get them to a place where they’ll be comfortable at home if that is what they want. Others will die here.”

For the many outpatients, visits to the hospice to see Sam and her team are just like visiting your GP or having outpatient appointments in hospital. “We deal with anyone with a life limiting progressive condition and in many cases that doesn’t mean they’re going to die in the next few days or weeks, but possibly in many years’ time, and they can still access our outpatient facilities.”

Trinity looks after adults of all ages – last year they were caring for patients with an age range from 19 to 106. And although we may associate the hospice with cancer, they now care for an increasing number of patients with dementia, currently the top cause of death in the UK according to the Office for National Statistics. On the lower ground floor of the ward, one room has been transformed to accommodate dementia patients, from the fresh white and contemporary spaces of elsewhere to dementia-friendly fixtures and fittings including ‘old fashioned’ taps, bright colours, chunky TVs, and pictures on the walls, all items more familiar to them.

Sam is one of four consultants at Trinity working alongside a team of junior doctors, specialist nurses and administrative staff, all of whom help patients and their families navigate their end of life care. They may have been trained to preserve, cure and save life but know that death is part of that and it is only natural. A final statement from Sam has stayed with me since we met. Holding out her cupped hands, she said, “We receive a patient and we hold that patient and his or her family; we work out what we’re going to do, and we do it well.”


Royal Trinity Hospice’s annual Family Walk & Fun Day takes place on Sunday 22 September.

NappyValleyNet users can get 50% off the registration fee with the code NAPPY.

www.royaltrinityhospice.london/event/family-walk

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