Dr. Alastair McAlpine has a perspective on life many aspire to but it’s one he’s earned doing a heart-wrenching job.
McAlpine cares for children in their dying days at Paedspal, a paediatric palliative program in Cape Town, South Africa. His name exploded around the world this month after he posted a profound series of tweets detailing what his patients – aged four to nine years old – valued most in life.
He shared that none of the kids wished they watched more TV and many named pets, family time, toys and swimming as the things they loved in life. He summed it up with this takeaway message:
“Be kind. Read more books. Spend time with your family. Crack jokes. Go to the beach. Hug your dog. Tell that special person you love them. These are the things these kids wished they could’ve done more. The rest is details. Oh… and eat ice cream.”
I spoke with McAlpine via Skype to find out more about what he hopes parents worldwide gain from these observations.
Laurel Gregory: What attracted you to paediatric palliative care in the first place?
Dr. Alastair McAlpine: I never saw myself going into palliative medicine and being in my final year of training, I saw a number of children who were clearly in their dying days and whilst we are very good at treating and curing children, we just weren’t very good at managing these little ones who we couldn’t cure anymore.
We made a lot of mistakes and a lot of the things I saw didn’t sit right with me and were actually quite upsetting. I thought to myself, ‘There really must be a better way. There’s got to be a better way.’
I spoke to a few colleagues about it and I got in touch with Dr. Michelle Meiring who is my boss now. She showed me there is a better way. There is a kinder, gentler way to manage children who are in the end stages of their lives and before I knew it she had offered me a job and here I was. I couldn’t believe it. I remember saying, ‘It feels like the field chose me, rather than I chose the field.’
LG: What concerned you about how those children were being treated?
Dr. M: Children [were] in their last day of life and we were still doing blood tests on them. We were still sticking needles in to them. We were giving them IV fluids when they didn’t need it. We were subjecting children to unnecessary ventilation when clearly what they needed was to be with their parents, rather than stuck on a machine. Giving them antibiotics when it was clearly their last day of life.
A lot of just these painful interventions that were unnecessary and what we should have been doing was giving them a human touch. A hug. A kiss. Allowing them to be in the arms of their parents instead of attached to a cold machine. That was just wrong.
LG: How are you able to care for dying children on a daily basis?
Dr. M: In terms of how I manage the job, I believe in my heart — I really do — that a good life deserves a dignified and pain-free death.
I think that a lot of these children have led beautiful lives and the least that they deserve is to die with dignity and grace. Not only in the last few hours but in their last few days and weeks.
I honestly believe that we need to maximize the joy that they can get, to maximize time with their families. I get a lot of meaning from just maximizing life for kids who have limited time left. I get a lot of personal joy and satisfaction and meaning from that and I think that is how I get up and face the kids every day.
Watch below: McAlpine explains what his terminally ill patients told him when he asked them what they valued most in life
LG: What didn’t make the list?
Dr. M: None of them cared how many Instagram likes they had.
The other thing that was important was none of them cared what people they didn’t know thought of them. They were only focused on their loved ones and those who were kind to them. That was what was important.
Not a single one said, ‘Sure, I wish I watched more TV.’ That’s not to say they didn’t like stories. They all liked stories but TV is quite disconnected. You’re starting passively at a screen. Whereas when their parents were reading a book to them or when they were playing with their toys, they were engaged and they were connected with their loved ones.
That made all the difference. It was the human connection that made all the difference.
LG: What is the biggest takeaway for parents in these kids’ observations of what matters in life?
Dr. M: The biggest takeaway: life is short and can change really fast.
Spend it doing the things you love with the people you love and tell those people that you love them. And I think if you do all of those things, I think you will look back on your life — whether it’s ending today or ending in many many years time — I think you’ll look back with gratitude and joy.
That would be my wish for everybody and certainly the wish for myself.
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