Want to go to the beach with family

 　　"Doctor, I'm really thankful to receive such a precious gift before I die." The 62-year-old female patient said to Dr. Konobu Nakamura with a smile on the couch. In late October 2020, on the second floor of a cafe in Setouchi City, Okayama Prefecture, Japan, they looked at the Seto Inland Sea and the islands in the sea under the clear sky.

　　In late July 2020, the patient was diagnosed with advanced colorectal cancer and was hospitalized in Tokyo. By October, she was thinking about where to spend the last days of her life. After discussing with her family, she was mentally prepared that long-distance travel during the severe epidemic would cause her condition to worsen. She chose to leave Tokyo, where she had lived for more than 40 years, and returned to the hometown where her mother and sister lived. She made an appointment for out-of-home escort services provided by the "Wish-fulfilling Nurse" agency and took the Shinkansen train back to her hometown accompanied by two professional nurses.

　　After returning to Okayama Prefecture, Dr. Nakamura became her attending physician. One day, the patient's sister asked the doctor, "Can my sister go out by car in her current condition?" She said that her sister wanted to go to a certain cafe. Nakamura immediately said yes, and said that he could travel with the patient, but the patient himself immediately rejected him. Nakamura knew she didn't want to cause trouble to others, so she didn't insist. But after that, the patient's sister called Nakamura and asked him to go with him.

　　In 2009, Nakamura established the "Wing Clinic" in Okayama County, which is open 24 hours a day, 24 hours a day, and provides door-to-door nursing services for dying patients. Nakamura said: "Many patients are expressionless when they are hospitalized, but smile when they return home. Our work as a home care doctor is also meaningful. This female patient has to work hard to return to the hospital under the severe epidemic. When I get to my hometown, I want her to fulfill her wish."

　　Ordinary doctors might refuse, but Dr. Nakamura decided to accompany her to the cafe without hesitation. Although it was an emergency trip, he still properly arranged a group of 14 people including the accompanying nurse and nursing manager to go to the destination.

　　Dr. Nakamura said: "This patient is usually reluctant to bother the medical staff, but he still acts like a eldest sister in the face of his younger sister, reminding her not to hold the cup before the doctor drinks tea. Many patients return home after being discharged from the hospital. Family duties, perhaps it has something to do with regaining vitality. Before the trip to the cafe, my sister told the patient that this might be the last time I was cared for by Dr. Nakamura, and the patient did not refuse."

　　A week after the cafe trip, the patient wanted to travel again and firmly told her family that she could. Another month later, Dr. Nakamura made a home visit, and the patient's family said the trip to the cafe gave the patient confidence and thanked the doctor.

　　In fact, during her hospitalization in Tokyo, she decided to stay in the hospital and wait for her death due to her condition worsening, but she returned to Okayama later. She was hesitant at the time, but it was the strong support of the medical staff that gave her strength.

| Indecisive end of life |

　　Not only this woman, but many terminally ill patients sway from side to side as their lives come to an end. Dr. Nakamura told me that even among the patients who have been discharged from the hospital, only 10% are willing to stay at home, 20% will eventually return to the hospital, and the remaining 70% have been hesitant about their destination.

　　Dr. Nakamura said: "My job is to communicate with patients and their families, and listen to the opinions of both parties. Of course, the opinions of the patients themselves are the first, and I am not adhering to the 'going home first'." The

　　Ministry of Health, Labour and Welfare of Japan announced from November 2018 Since the beginning of this month, citizens and the elderly are encouraged to hold a "life meeting" at home in advance to communicate how to spend the last period of their lives. Affected by the new crown epidemic, in August 2020, the Japan Geriatrics Association emphasized that such preparations must be made in advance, because once a patient is hospitalized, he may not even be able to see his family before his death.

The female patient, who returned to her hometown from Tokyo, is looking out with her mother from the cafe on the second floor of the Ushikado Olive Farm in Setouchi City. This was the last time she came to this place that she missed deeply.

　　According to a survey conducted by the Ministry of Health, Labour and Welfare in 2017, 60% of respondents hoped to live at home when they died, but in fact, more than 70% of Japanese died in hospitals. Dr. Nakamura suggested: "If a terminally ill patient decides to leave the hospital, please make full use of medical insurance with your family and choose home care services, so that even if both husband and wife still need to work or are old and retired, they can cope. of care services may not be realistic, but appropriate utilization is feasible.”

| Don't want to show pain |

　　Affected by the new crown epidemic, the number of hospitals banned from visiting the inpatient department is increasing, and the wishes of patients and their families are difficult to achieve. This is a fact. Ms. Kazuya Maeda from the "Nurse Who Fulfills Wishes" said: "After the outbreak of the new crown epidemic, the demand for travel companion care has decreased, but the number of people who choose to discharge home care and book a nurse to accompany them home has increased."

　　November 2020 , Maeda accompanied the 84-year-old patient Hiruma Hiroichi to be discharged from the hospital and take a special car home. In the previous year, Biruma had suffered four cerebral infarctions, and then repeatedly contracted the complications of aspiration pneumonia, and finally was hospitalized for blood in the stool. Although the hospital has not issued a critical illness notice, his condition is not optimistic.

　　During the epidemic, Hiruma's wife Tokiko had only 20 minutes of visit time a week. Biduma strongly expressed his desire to go home, and after consulting with the hospital, he finally got three hours to leave the hospital and go home.

　　The soft sunlight shone in the living room, and Biruma was lying on the nursing bed by the window, with the 62-year-old eldest daughter on his right, showing him the dishes in the red saucer. His daughter personally made three dishes for him, namely rice porridge covered with small pieces of grilled eel, pudding wrapped with thin strips of Nagasaki cake, and glutinous rice balls with red bean paste. These should be the food that my father can eat after he is really discharged from the hospital.

　　Dezi said: "During the hospitalization, I also need to fast when I go home for a short time. My daughter thinks that my father likes eating eel and bean paste so much, even if I can't eat it now, I will be happy to see it, so I made these specially for him. She also chopped buckwheat noodles, thickened the soup to make liquid food, and packed it in a fresh-keeping bag for her father to take back to the hospital to eat."

　　Bi Yuma used to work at a TV station, and his former boss and his family made an appointment in advance to meet him at the hospital. He came to visit on the day he came home. Maeda thoroughly sanitized the hands of everyone present, and everyone except Hiruma himself had to wear masks. Maeda prepared a portable sputum suction device in advance because the saliva could be sucked into the trachea at any time.

　　She said: "In order to try not to let the patient show a painful expression in front of everyone, I put some cushions next to the armrest of the nursing bed, quickly sucked the patient's phlegm under the cover of the cushions, and then removed the cushions." The printing and mounting of the group photo was arranged so that when Biduma returned to the hospital, the photo could be seen immediately.

　　Dezi expressed his heartfelt thanks for this: "Although my husband only stayed at home for just three hours this time, it made me look forward to his next return home after the epidemic improves. I feel very relieved to have Maeda to take care of him. Her intentions have comforted us who have spent a short time together."

　　During the epidemic, those who ran for the dying patients included both well-intentioned medical staff in the hospital and professional institutions such as "wish-fulfilling nurses". In addition, there are some companies that offer free services. The main business of "Tawu" is the repair and reuse of accident vehicles. The company created the "Wish Car" program to serve terminally ill patients, listen to their true wishes, provide them with professional nursing vehicles and nurses, and transport them to where they really want to go at the end of their lives.

Hiruma Kyoichi shook hands with his former boss, Shigeru Suzuki.

　　Miyamoto Mingyue, president of "Tawu" company, said: "In addition to nurses, ordinary members of our company will also travel with patients. I want them to truly appreciate the importance of life and health, understand that corporate profits can be returned to the society, and Make employees proud of their work."

| Care that follows the patient's wishes |

　　In September 2020, Yukiko Ono came to a seaside hotel in Gamagori, Aichi Prefecture. The 63-year-old was diagnosed with breast cancer five years ago, and since July 2019, her health has taken a sharp turn for the worse. Before the end of her life, she wants to revisit the old places with her close relatives and friends, and go to her favorite beach again.

Yukiko Ono said to her grandson, who had just returned from a trip to the beach, "I want to smell the sea.

　　A friend caught a pair of unicorns, Ono gave them to his four-year-old grandson, and asked him happily, "Do you know what unicorns eat?" Her daughter remained silent. Ono's cancer cells have spread to the surface of the skin, and a large rash has ruptured. Her clothes are stained red with body fluids and blood. She needs blood transfusions twice a week. On this day, Ono wore a dark navy blue top, the same color as his grandson's hat. She chose the dress so that her grandson and people around her would not notice her bleeding. Five days later, Ono died.

　　On the day I went to the beach, Shusaozhi, who worked in "Tawu", accompanied Ono with his relatives and friends. Seeing the smiling patients and their relatives and friends, Jiujiao deeply realized how important the patient-centered medical service is. She said: “Hospitals tend to prioritise medical efficiency and use a nasogastric intubation to ingest nutrient solutions in cases where patients may have aspiration pneumonia because the hospital finds it easier to do so. Personnel are also prone to fall into the habitual thinking of 'it is safer not to go out at the end of life'. In fact, these practices often ignore the patient's heart."

　　After Ono's death, her eldest daughter was very depressed for a time. One day, her son gave her a memory card with footage of the day of the trip at the beach. In the video, her mother's smile finally relieved her, and she also understood that the nursing method her mother chose in the last journey of her life was to follow her own heart.