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On the Other Side of the Stethoscope: How a Doctor’s Brush With Death Pushed Him into the Arms of Hospice Care

It’s a story straight out of any doctor’s worst nightmare.

Dr Naseem Tariq was a cancer surgeon and specialist, working in acute care. Just as many of his fellow hospital-based physicians did in the early stages of 2020, during the first throes of the coronavirus pandemic, Dr Tariq caught COVID-19 himself. Unlike other colleagues who contracted COVID his condition deteriorated quickly. 

Surviving COVID-19

Dr Tariq was placed on an end of life pathway, with a prognosis nothing short of devastating. In his own words, “there was no hope that I was going to survive”.

But he did. Despite declining the use of a ventilator, Dr Tariq was able to conservatively manage himself back to health, beat the virus, and survive.

Since the dawn of time, societies and cultures have placed a kind of salience on deathbed experiences – the epiphanies and realisations that emerge in the face of our potential demise. So what does a doctor – who finds himself not only on the wrong side of the stethoscope, but thrust face to face with his own mortality – learn from such a harrowing turn as a patient?

“As an end-of-life patient myself, I was felt that people never really took the time to understand what was going on with me. They asked a few standard questions, and then walked away.

"Leaving you as a patient in a very lonely place.”

With the pandemic continuing to rage, and the doctor’s perspective of acute care for End of Life fundamentally altered, Tariq became aware of ellenor through a connection with one of our staff, Dr Sheraz Majeed. ellenor is a hospice charity which cares for patients with life-limiting conditions in the Kent and Bexley localities. After Dr Tariq’s life-changing battle with illness, it was the perfect fit.

“I wanted to broaden my perspective and widen my experience, so I decided to apply to work in palliative medicine,” Dr Tariq shares. “Not working as a surgeon, but as a physician looking after patients at the end of their lives – because I have been there, and I know how lonely it is.”

Dr Tariq describes his move to ellenor as “very therapeutic” and having “offered the new perspective he was looking for”. But he’s also been able to carry over his proficiency working in an acute setting to its palliative counterpart, bringing to bear two decades of experience in a hospital to a radically different environment.

“Hospital doctors don’t know what happens to their patients when they become end of life and are transferred out of an acute setting. There’s a lot of pressure on the acute doctors, so they have no choice but to quickly turn their attention to the next patient in need of acute care. Being at ellenor now, I see that perspective – I see those patients as human beings who are no longer in the hospital, but still have a journey left in them."

"I see patients embark on a journey with us, and witness first-hand how much value we add – how much quality of life we enable them to have."

“The choices I’m able to give my patients here, I wasn’t able to provide in an acute setting because of time, acuity of patients, and different types of facilities the acute setting offers. Here, I can spend an extra half an hour with a patient. That’s what hospices can do that nobody else can. But at the same time, it’s a very different type of practice. It has a whole new impact on your personality. It changes you as a human being.”

A key tenet of ellenor’s ‘holistic’ approach to palliative care involves catering to the multiple aspects of a patient’s health. That includes treating their emotional, spiritual, social, and psychological needs, as well as their physical ones. 

“What we do here is stand by our patients”, Tariq asserts. “We are there, holding their hand and being partners in their journey. We stand in for people’s fathers, mothers, grandparents, children – we are still available, even when others have left.”

The Importance of Nurses

Exemplifying the personalised, passionate approach of hospice care, Dr Tariq believes, are the efforts of ellenor’s nurses. They work both from the charity’s Northfleet-based inpatient ward, as well as providing care directly from the homes of their patients in the Gravesend community.

“No one makes this observation, but the nurses at ellenor are doing things for their patients that they probably didn’t do for their own new-born children. Here’s a dying adult, for instance, who is agitated, and totally dependent on them for personal care. The patient has wounds, they’re incontinent, they have difficulties eating.

"Nurses help them every day, and with a smile.”

Dr Tariq provides the example of one young cancer patient, who was in their late twenties when they approached the final stages of their life. “Their bravery was remarkable, but we know they were going through a bad, downhill journey in the end.

“Patients facing end-of-life face difficult situations and this can be challenging for healthcare professionals. A broad multi professional team approach, an area that hospices specialise in,  is needed to support these patients and their families along their journey and the challenges they face. We managed to forge a good relationship, even with the family, and when they passed away everyone was happy that the hardship had ended in a positive way. There was closure and the family were pleased.

We are still in contact with family members and offer them support, ask them to come in for a coffee, and keep the door open for them to talk to us if they want to remember. Those are the kinds of things that you can’t do in a hospital setting.  

As the doctor’s anecdote suggests, ellenor’s ethos of care isn’t limited solely to the patients themselves. The charity is also committed to supporting the needs of the family members and loved ones of those under its care. However, as Dr Tariq explains, this comes with its own collection of complex challenges.

Support for the Whole Family

“Families are not always understanding of what is happening to their loved one. They think they have enough information; that they can vent their frustrations and emotions on the nurses, and then walk away after their two-hour visit. But they don’t really understand what happens for the remaining 22 hours of the day, and how we are helping. We work with the patient’s family to increase that understanding and address their fears for the future.

Another patient, Tariq recalls, was a frail woman at the end of her life. Her grown-up child was traumatised by the lack of time they had spent together over the years. There was no support network in their life to offer support and they were suffering.

“Their behaviour was erratic”, Dr Tariq remembers "accusatory and finger-pointing to all the staff, something again that hospices recognise goes with the difficult situation that patients and families find themselves in.  So one day, we had an open, one-to-one chat. I explained that I felt their behaviour to be a way of trying to make up for their guilt and trauma, but that it was negatively impacting our ability to care.

“When they realised that, they broke down. After that conversation, they were wonderful to the nurses, and were able to get a sense of closure. We allowed them time to grow into that frame of mind, and supported them both, their mother passed away here after a long illness.

“Again, this is the kind of time that hospitals struggle to give families. So – though it feels slow here, though it’s quieter here – this is how you want it to be. Otherwise, we’d be doing exactly what they do in a hospital. Then, we’ll no longer be doing what Hospices do best giving patients and families time – time to talk, time to think and time to address their concerns." 

Hospice Care for all Cultures

But is this approach valued? Do hospices receive the same kind of cultural kudos as their acute counterparts? Dr Tariq believes they are – in the UK, at least – although, globally, it’s something drawn very much along ethnic lines.

“I come culturally from a background where there is no concept of hospice or nursing homes. In Asian and Middle Eastern culture, people tend to have larger, joint families where they keep their elderly. Their older relatives live with them, and they die at home. But as civilization develops, I’m seeing even those families and cultures struggle.”

Gravesend is profoundly multicultural, with a large Asian population and thriving Afro-Caribbean communities. With greater knowledge of what hospices can offer these groups – and increasingly diverse representation within the ranks of palliative care teams across the Kent and Bexley areas – Dr Tariq wants to pave the way for a new breed of “multi-ethnic hospice”.

“I think the average Asian family isn’t aware of what a hospice does – it’s an unknown idea to them. But if they know that there are two Asian doctors working here, we can talk to them about it; they can share our experiences. If families feel supported – whichever religion they’re from – and know that they can get meals of their choice and tailored care, that’s important to us.”

“I am not aware of many diverse hospices. ellenor can be the leader of that, can make a statement. We can reach out to all communities, even the ones that no one else is. These things don’t increase costs, but they do require a shift in focus in terms of how you approach people. We could go to the local mosque, hand out brochures… tell them that we’re taking pride in looking after the Muslim community.”

Today, Dr Tariq is feeling good. He’s been back at work for almost a year, is fully vaccinated, and is living life completely free of COVID-19 symptoms. But the events of early 2020 – or, more importantly, there implications for his worldview and career – are far from forgotten.

“As doctors, we tend just to think about the mechanical tools; the diagnosis, the treatment, the history. But despite all the empathy we feel for the patient, unless we’ve been there ourselves – unless we’ve suffered ourselves – we can’t fully understand what they’re going through. I’m fortunate; both in that I survived, and that I can now use the knowledge from my experiences as an end of life patient to help others.”

Once, Dr Tariq’s prognosis was bleak. But 18 months on from his harrowing dance with death, his future at ellenor – helping life-limited patients and their families through the darkest times of their own lives – is much brighter.

“This is the only hospice that I know, and I think it’s the perfect place to be."

"It’s a pleasant environment, the right kind of place – with the right kind of people. It’s a good cultural mix, and, when someone comes to us – whose daughter isn’t here, or who doesn’t have a child, or who has lost their husband – we give them the space they need. We work with them, and we give them choices, support. I believe they feel that we are their family.”