Palliative Care Model

I used to equate palliative care with these- defeat, failure and of course, death. Don’t all of the palliative care patients die? How else would a naive student define death? Had I not just spent years and years, learning how to save people’s life? ‘No, we are not going to offer curative treatment. No, we are not going to resuscitate. No, this patient will not live. It’s about time.’ Everything about it was negative.

My mum was diagnosed with nasopharyngeal cancer in 2012. She went through multiple major surgeries, cycles of chemotherapy and radiotherapy due to recurrent disease. Leaving her with pain, unilateral hearing loss, weakness of the facial muscles, tingling of hands and feet, loss of sense of taste and difficulties in swallowing

as the side effects of previous treatments. Life wasn’t easy for the past three years but what kept her going was the hope of being cured. Eight months ago, PET scan showed meningeal metastasis. ‘It is not curable. No more treatments can be given. I’m sorry.’ said the doctor. To us, that was a death sentence. Did we have a good amount of treatment previously? If yes, why didn’t it work? Can we not have any more than that? So, what’s next? Waiting to die? Negativity reinforced, endless struggles.

Then I met Mr. G, a pleasant 75 years old gentleman with the background history of colon cancer that widely metastasized to lungs, liver and spine. He had a left-hemicolectomy, liver stenting and some radiotherapy done in 2014. Due to his other comorbidities such as ischaemic heart disease, diabetes mellitus and chronic obstructive pulmonary disease, he is not fit for aggressive treatments and therefore, goes down the route of palliative care. Mr. G was admitted to the hospital because of uncontrolled lower back pain despite taking Zomorph 200mg BD and Oramorph 80mg PRN up to four times in a day. Tiredness and breathlessness became worse, his daily activities were limited. Although there were difficulties at times, Mr. G enjoyed every little things and treasured every single moment in life. He accepted the inevitability of death and was at such peace with it, but what worries him the most is his 70 years old wife with Alzheimer’s disease that he is going to leave behind.

Palliative care team was involved in Mr.

G’s inpatient care. The key principles to work on are 1) Focus on the quality of life- Many people who are living with a terminal illness often talk about quality of life and strive to retain control over it. It is important for us to understand what does quality of life actually mean to each patient and how can we contribute to attain or maintain the goal. 2) Take into account the patient’s past life experience and current situation- Experiences shape and make us the person we are today, but they also shape our views and expectations of a situation. It is easy to talk about the ‘here and now’ with patients whilst failing to pick up on the vast richness of their past and questioning from where their ideas and views have arisen. 3) Care which encompasses the dying patient and those who matter to them- There is no easy task when each individual may have entirely different needs, may be at different stages of acceptance and understanding of the situation, and different expectations of what healthcare professionals are able to offer. Good communication, skills and expertise of the palliative care multi-disciplinary team is the key to offer a support network for those who involved in patient’s care. 4) Respect patient’s autonomy and choice- Sometimes, we may find that our own values are challenged in a way that patient may not always make decisions which we believed to be in their best interest. If the patient is thought to be competent

and they have received appropriate information, the choice lies with them and it is our duty as healthcare professionals to accept and support their wishes. 5) Emphasis on open and sensitive communications- Many patients with terminal illness feel isolated and it is exacerbated by the fact that those around them often find it difficult to talk about. It is not because of they are lack of sensitivity but oftenly, they just don’t know what to say. It takes a lot of courage for patients to talk openly about illness, future plans and death. We don’t know where the conversation may lead to and there may be questions that we don’t know how to respond to or answer. However, offering a listening ear is therapeutic in itself.

Six weeks of hospital rotation with great exposure to Oncology and Palliative Medicine changes my view on palliative care and death.

Just as we witness life, we must witness death. It is neither defeat nor failure, but a normal process in life. It is always devastating for the patients and their family members to be given a diagnosis of terminal illness, with the feeling of hopelessness as there is nothing more that can be done. It’s not totally true! No matter how big or small the intervention is, there is always something that can be done. And oftenly, it is the little things that make a huge difference to the patients and their family

members.